Nikolaev A P, Nikoda V V, Svetlov V A
Anesteziol Reanimatol. 2008 Sep-Oct(5):99-103.
Chronic neuropathic pain syndrome observed prior to surgery not only influences the intensity of pain, but also reduces the efficiency of selective use of analgesics. The purpose of the investigation was to study the efficiency of various analgesics and their combinations after lumbar microdiskectomy. Seventy-six patients who had undergone lumbar microdiskectomy and who suffered from chronic back pain were examined. According to the mode of postoperative analgesia, the patients were divided into 4 groups: 1) 20 patients received i. m. promedol 20 mg (a control group); 2) 20 had i. v. tramal (patient-controlled anesthesia); 3) 18 were given i. v. xefocam 24 mg/day; 4) 18 i. v. ketamine 0.1 mg/kg/hour + i. v. xefocam 24 mg/day. Their analgesic effect was evaluated using a visual analogue scale 1, 2, 4, 6, and 24 hours after surgery. The use of xefocam in combination with microdose ketamine was ascertained to cause no increase in the frequency of adverse reactions, to upgrade the quality of analgesia, and to minimize the intensity of pain 24 hours following surgery.
术前观察到的慢性神经性疼痛综合征不仅会影响疼痛强度，还会降低选择性使用镇痛药的效果。本研究的目的是探讨腰椎间盘切除术后各种镇痛药及其联合使用的效果。对76例接受腰椎间盘切除术且患有慢性背痛的患者进行了检查。根据术后镇痛方式，将患者分为4组：1）20例患者肌肉注射20mg丙氧吩（对照组）；2）20例患者静脉注射曲马多（患者自控镇痛）；3）18例患者静脉注射24mg/天昔布康；4）18例患者静脉注射0.1mg/kg/小时氯胺酮+静脉注射24mg/天昔布康。在术后1、2、4、6和24小时使用视觉模拟评分法评估其镇痛效果。已确定昔布康与小剂量氯胺酮联合使用不会增加不良反应的发生率，可提高镇痛质量，并在术后24小时将疼痛强度降至最低。
