Ovechkin A M, Gnezdilov A V, Arlazarova N M, Savin I A, Fedorova E V, Khmelkova E I
Department of Anesthesiology, Central NII of Prosthesis, Moscow.
Anesteziol Reanimatol. 1996 Jul-Aug(4):35-9.
A total of 152 patients subjected to operations mainly of an orthopaedic profile were divided into 8 groups for the development of the optimal method of preventive analgesia. The best results were attained by combined use of opiate premedication, regional blocking as a component of anesthesiologic care, and parenteral diclophenak-Na before and after the operation. 31.5% of patients in this group did not need any postoperative analgesia. In the rest cases we observed the longest postoperative pain-free period, the least intensity of pain, and low need in additional analgesics during the first 24 h postoperation in comparison with the control groups (p < 0.05), in which one or several of the above components were excluded from the protocol of anesthesia. Preventive analgesia reduced the incidence of phantom pain syndrome after limb amputation in patients with the preamputation pain from 63.3 to 25.1%. The postoperative pain syndrome may be prevented if the factors determining it (preoperative pain, intraoperative nociceptive stimulation, and perioperative tissue inflammation) are eliminated simultaneously.
共有152例主要接受骨科手术的患者被分为8组，以制定最佳的预防性镇痛方法。通过联合使用阿片类药物术前用药、作为麻醉护理一部分的区域阻滞以及手术前后静脉注射双氯芬酸钠，取得了最佳效果。该组31.5%的患者术后无需任何镇痛。与对照组相比（p<0.05），在其余病例中，我们观察到术后无痛期最长、疼痛强度最低，且术后24小时内对额外镇痛药的需求较低，对照组的麻醉方案中排除了上述一种或几种成分。预防性镇痛使截肢前有疼痛的患者截肢后幻肢痛综合征的发生率从63.3%降至25.1%。如果同时消除决定术后疼痛综合征的因素（术前疼痛、术中伤害性刺激和围手术期组织炎症），则可以预防术后疼痛综合征。
