Osipova N A
Anesteziol Reanimatol. 1994 Jul-Aug(4):16-20.
The author analyzes the results of experimental and clinical studies of various central action analgesics used for total anesthesia, postoperative analgesia, and chronic pain relief in cancer patients. General shortcomings of all opioid analgesics were revealed: analgesias not always full-value because of different individual sensitivity to opioids, and side effects were often serious. The latest progress of the fundamental sciences in research of the mechanisms of pain and body responses related to pain helped improve the available and develop new more effective methods for total anesthesia and postoperative analgesia on the basis of opioid analgesics with the use of special nonopiate components compensating for the defects of opiate analgesia: clofelin, an adreno-positive agent; acelysin and contrykal, prostaglandin and kinin synthesis inhibitors. Synthetic opioids of the latest generation (buprenorphine, tramadol) were found preferable in the treatment of chronic pain in cancer vs. morphine and its analogs; an alternative scheme of drug therapy of chronic pain on the basis of these drugs is offered which is highly effective and causes the minimal side effects.
作者分析了用于全身麻醉、术后镇痛以及缓解癌症患者慢性疼痛的各种中枢作用镇痛药的实验和临床研究结果。揭示了所有阿片类镇痛药的普遍缺点：由于个体对阿片类药物的敏感性不同，镇痛效果并非总是完全有效，且副作用往往很严重。基础科学在疼痛机制及与疼痛相关的身体反应研究方面的最新进展，有助于在使用特殊非阿片类成分弥补阿片类镇痛缺陷的基础上，改进现有的并开发新的更有效的全身麻醉和术后镇痛方法：可乐林，一种肾上腺素能激动剂；乙酰水杨酸和抑肽酶，前列腺素和激肽合成抑制剂。发现新一代合成阿片类药物（丁丙诺啡、曲马多）在治疗癌症慢性疼痛方面比吗啡及其类似物更具优势；基于这些药物提供了一种慢性疼痛药物治疗的替代方案，该方案高效且副作用最小。
