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The article goes to describe clinical and pharmacological approaches to choosing a drug with an optimal efficacy/safety profile, providing the necessary analgesic effect in tension-type headache. TRPV1 brain receptors are considered the main action point of the mediator., Aim: The purpose of this study is a comparative analysis of the pharmacodynamic and pharmacokinetic parameters of ibuprofen and paracetamol as a part of fixed dose combination and as monotherapy in tension type headaches., Materials and Methods: Comparative dissolution kinetics test; Comparative analysis of pharmacokinetic parameters using the PubMed/MEDLINE database., Results: The median Tmax of ibuprofen as a part of a fixed-dose combination and as a monotherapy is 75 minutes. The median Tmax of paracetamol is 30 min when taken in a fixed dose combination and 40 min as a monotherapy. In patients who received the fixed dose combination, the concentration of ibuprofen in the blood plasma after 10 minutes 6.64 g/ml-1; after 20 minutes 16.81 g/ml-1, while when taken in the same dose in as a monotherapy, respectively, 0.58 and 9.00 g/ml-1. The mean plasma concentrations of paracetamol after 10 and 20 minutes in patients receiving the fixed combination were 5.43 and 14.54 g/ml-1, respectively, compared with 0.33 and 9.19 g/ml-1 for paracetamol as monotherapy. dissolution kinetics test of the Paracytolgin: after 5 minutes, 20% of paracetamol passed into the solution in a system with a pH of 1.2; in a system with a pH of 4.5 36.4%; in a system with a pH of 6.8 33.5%; after 10 minutes, respectively 68.5, 98.0 and 89.6%. After 15 minutes, almost complete dissolution was noted in all systems: 98.5, 98.8 and 100.5%, respectively., Discussion: The combination of ibuprofen and paracetamol makes it possible to enhance the analgesic effect as a result of additive action by the help of central mechanisms. The fixed dose combination of ibuprofen and paracetamol significantly increases the rate of absorption of paracetamol, which has potential therapeutic benefits in terms of a faster analgesias onset., Conclusion: The fixed dose combination of ibuprofen and paracetamol provides faster and long-term anaesthesia with a comparatively lower dosage of each analgesic.

So far, the ongoing debate about the appropriateness of combining drugs with different mechanisms of analgesic action for optimal antinociceptive protection. The review deals with the theoretical calculations arguing with the physiological rationality for the inclusion of central α2-agonists in the scheme of modern multimodal analgesia. We have presented data from recent reviews regarding the efficacy and safety of intraoperative application of dexmedetomidine as a one of the latest drugs in this class.

Unlabelled: The article deals with a study of efficacy and safety of the dexmedetomidine as an analgesic adjuvant drug for anaesthesia during laparoscopic gynecological and abdominal surgeries. Patients and methods: 32 patients received intraoperative infusion of dexmedetomidine. We assessed an effects of dexmedetomidine on data of central circulation during surgeries., Conclusions: The use of dexmedetomidine allows to decrease an amount of opioid analgesics, inhalation anaesthetics and to avoid severe changes of circulation during traumatic phases of surgeries.

Objective: To develop effective and safe measures of postoperative multimodal analgesia (optimizing the use of narcotic analgesics) in surgical treatment of hematological patients with thrombocytopenia., Design: A pilot and prospective comparative controlled study., Methods: We studied 27 patients with acquired thrombocytopenia who underwent laparoscopic splenectomy. Three schemes of anesthesia were used: 1) Nefopam 20 mg/day + trimeperidin (n = 7); 2) Paracetamol 4 g/day + trimeperidin (n = 10); 3) paracetamol + trimeperidin + glucocorticosteroids (GC) (through treatment of the underlying disease) (n = 10). Analgesic properties and effect of each scheme were assessed according to a rating scale of pain NRS (10 points) and VAS (100 points) studied. Additionally we evaluated the effect of nefopam and paracetamol on the functional properties of platelets and hemostasis, platelet levels while monitoring and indicators of thromboelastogram (TEG)., Results: Application of paracetamol + trimeperidin accompanied with effectively reducing of postoperative pain (less than 5 points on the NRS). The level of postoperative pain was lower in patients who were treated with corticosteroids within the therapy of the underlying disease before surgery and who continued to receive it in postoperative period (2-3 points NRS). Nefopam use in the perioperative period is not only inferior to the analgesic effect of paracetamol, but also causes frequent side effects. Consumption of narcotic analgesic--trimeperidin when applying nefopam averaged 43 mg/day, the appointment of paracetamol--28 mg/day, using a combination of paracetamol + GC--20 mg/day. Thus, GC within the underlying disease treatment substantially reduces the need for opioid analgesics. A monitoring of the number of platelets and TEG did not shows negative effect of paracetamol and nefopam on platelet and plasma hemostasis., Conclusions: Nefopam and paracetamol may be used in patients with thrombocytopenia, as do not affect the hemostasis and platelet count. Application of postoperative analgesia scheme paracetamol + trimeperidin in patients receiving corticosteroids provides the maximum reduction of pain with the least consumption of narcotic analgesics.

Comparative study of postoperative analgesia and sedation with trimeperidine and dexmedetomidine and their effects on haemodynamics and vegetative nervous system was performed. Assessment of analgesia and sedation during vagotonia (first part of the study) and hypokinetic type of haemodynamics (second part of the study) was carried out with visual analogue scale (VAS) and Richmond scale. Results of the study showed that dexmedetomidine is more effective and safer than trimeperidine for analgesia and sedation in patients with spontaneous breathing after abdominal surgery. Dexmedetomidine use allows keeping optimal type of haemodynamics and vegetative nervous system parameters on first day of postoperative period.

4 combinations of analgesia were studied: 1) Nefopam and patient-controlled analgesia (PCA) with Trimeperidine; 2) Ketoprofen (100 microg each 12 hours intramuscular) and PCA with Trimeperidine; 3) Nefopam, Ketoprofen and PCA with Trimeperidine; 4) PCA with Trimeperidine as monotherapy in early postoperative period in cardio-surgical patients. 80 patients (age from 40 to 70) were divided into 4 groups, 20 patients in each group. Administration of Nefopam and Ketoprofen before extubation reduced the intensity of pain syndrome (in average on 90%) and promoted the early stirring up of patients. Combination of Nefopam and Ketoprofen provided the most expressed analgesic and opioids-saving effects. In this group average amount of Trimeperidine per 24 hours was 14.7 microg that was 4.9 times less than in group of PCA with Trimeperidine as monotherapy. Dynamics of maximal inspiratory capacity of the lungs in the first three groups was better than in group of PCA with Trimeperidine as monotherapy beginning from 6th hour of study. In common undesirable effects was connected with Trimeperidine administration and depended on its dose. The frequency of nausea, vomit, dizziness and weakness was authentically higher in the group of PCA with Trimeperidine as monotherapy than in other groups.

Unlabelled: The study was carried out to compare analgesia, the side-effects incidence and the need for analgetics when you use the continuous iliofascial block (CIFB) versus epidural analgesia (EA) after the total hip joint endoprosthesis (THJEP). 60 patients undergoing planned THJEP under spinal anaesthesia were included in a randomized controlled study. The day before the surgery all patients were divided into 2 groups (30 people each). In the 1st group postoperative analgesia carried out on the basis of the EA, and in the 2nd group - CIFB. All patients received balanced analgesia with nonopioid analgesics, and in case of pain syndrome - tramadol injections. In the 1-st group the value of the visual-analogue scale - VAS (0-100mm) 6 h after the operation was significantly lower at rest and in motion. The maximum average value of VAS in motion was 2.3 +/- 2, 1 mm in EA group and 3.2 +/- 2.6 mm in CIFB group. Frequency of tramadol use in 1-st and 2-nd groups was 6.9% and 41.4%, and of nausea - 34,5% and 6.9%, respectively. Patient analgesia satisfaction was higher in the 2nd group., Conclusion: Extended IFB provides a good level of analgesia in patients after THJEP. Prolonged EA exceeds CIFB in analgesia, but is accompanied by a greater frequency of postoperative nausea occurrence.

This article reviews the possibility of the use of paracetamol (perfalgane) as an analgesic component of medical sedation. The actuality of the problem is the choice effective pharmacological means of protection from peri-operative pain. The theoretical advantages of paracetamol in the scheme of sedoanalgesia are exquisite. We describe a personal experience of efficacy assessment and safety of paracetamol as an analgesic component of the methodology of drug sedation for bronchoscopy in the early postoperative period. We compare analgesia by the means of paracetamol 1000 mg (IV) and tramadol 100 mg (IV). The sedative agent in both groups was midazolam. It turned out, that despite the high efficacy of tramadol as a component of sedoanalgesia, the quality of anialgesia when using perfalagane is almost 5 times higher, both due to the significant number of good results, and to reduced number of adverse events. Use of paracetamol (Perfalgane) instead of tramadol for medical sedation during fibrotracheoscopy in patients in the early postoperative period leads to better quality of analgesia, thus avoiding such undesirable phenomena as hypersedation, respiratory depression, dizziness, and nausea.

The study comprised a total of fifty-three patients after endured operations performed on the infrarenal portion of the aorta and large vessels of the lower extremities. The work was aimed at evaluating quality of postoperative analgesia in various regimens of multimodality analgesia based on non-narcotic analgesics. The following combinations of the drugs were used: ketoprofen + tramadol; lornoxicam + tramadol; paracetamol + tramadol; paracetamol + lornoxicam + tramadol. The use in the postoperative period of the above mentioned regimens of multimodality analgesics makes it/nmpfble to achieve a good analgesic effect without administration of narcotic analgesics. The inclusion of paracetamol into the postoperative multimodality analgesia results in a rapid onset of an analgesic effect and decreased requirements in prescribing tramadol. In patients running a high risk of an ulcerogenic effect of non-steroidal anti-inflammatory drugs, postoperative analgesia should be carried out based on paracetamol and tramadol whose combination appears to provide a beneficial analgesic effect.

Rat intoxication with acetaminophen (APAP) (500-1500 mg/kg body weight intragastrically) caused a considerable dose-dependent decrease in reduced glutathione (GSH) level in both liver cellular cytoplasm and mitochondria (at the dose 1500 mg/kg body weight by 60% and 33%, respectively). The cytoplasmic GSH level decreased more pronounced by comparison with that in mitochondria. At the same time, we did not observe any inactivation of the mitochondrial enzymes: succinate dehydrogenase, alpha-ketoglutarate dehydrogenase, glutathione peroxidase despite of mitochondrial GSH consumption; also we did not observe any decrease in the respiratory activity of liver mitochondria isolated from APAP-intoxicated rats. A tryptophan derivative, melatonin (10 mg/kg body weight), did not prevent intramitochondrial GSH oxidation, but decreased the hepatoxity of APAP, diminishing the activities of AlT and AsT as well as bilirubin level in blood plasma of intoxicated rats. N-acetyl-nitrosotryptophan (a nitric oxide donor) did not exhibit any hepatoprotective effects.

The influence of non-narcotic analgesics analgin and pentalgin in the basic pharmacological effects of diazepam and mexidol has been studied in outbred male albino rats. It is established that both analgesics do not influence the activity of diazepam. At the same time, they potentiate the analgesic action of mexidol without influencing its antistress action and not inducing any side effects. The strengthening influence of pentalgin was more pronounced. It is concluded that mexidol can be administered in combination with non-narcotic analgesics, in particular with pentalgin, for relieving painful syndrome on the background of stress.

The advantages and drawbacks of using paracetamol in the treatment of dystrophic and destructive lesions in connective tissues are considered.

On the basis of comprehensive experimental and clinical research the authors defined a variety of migraine-related mechanisms and schemes of migraine-correction by drugs, which should be both of the vascular- and general-actions to ensure an effective medication.

Paracetamol is a well-known analgetic-antipiretic drug widely used in medical practice. In therapeutic doses (4 g/day for adults and 60 mg/kg/day for children) paracetamol relieves fever and non-severe pain with minimal risk of complications both in adults and children. But medical professionals should know that in extremely high doses (above 10 g for adults) paracetamol has a hepatotoxic effect. Overdose intake of paracetamol in Russia happens rarely, it occurs by chance or in attempted suicide. In such a case the antidote must be used to protect the liver. This antidote for paracetamol is N-acetylcysteine.

The purpose of this clinical investigation was to compare analgetic effect of analgin and Ketanov on posttreatment pain after canal filling in 50 patients with pulpitis and periodontitis. Clinical data have shown Ketanov effectiveness, absence of side effects. Marked reduction of pain was shown in all patients getting Ketanov, no analgetic effect was revealed in 20% patients getting analgin.

Analgesia with nonsteroid antiinflammatory drugs (NSAID) becomes a pressing problem today. One such drug is ketorolak tromethamine (KT), characterized by expressed analgesic activity comparable with that of opioid analgesics morphine or promedol. Our purpose was to assess KT efficacy in analgesia performed by different methods, including analgesia controlled by the patient (ACP) after surgery. In medium severe and strong pain KT was used in group I (n = 60) "as needed" in a dose of 30 mg up to 3-4 times a day, in group 2 (n = 12) by the ACP method, in group 3 (n = 16) KT was incessantly infused in a daily dose of up to 120 mg, and in group 4 (n = 11) KT was injected 3-4 times a day in a dose of 30 mg in combination with morphine ACP. The results indicate a high efficacy of KT: 83% after a single injection. Combined use of KT and promedol decreased the dose by 40-50%. Side effects were observed in 15% of patients: most often it was a sense of fever and sweating (in 4% of patients), nausea and vomiting (in 2%), insomnia (in 2%). ACP and planned injections in a daily dose of 90-120 mg is the optimal method of analgesia in patients after extensive surgical interventions.

The efficacy of postoperative pain relief by ketanov and tramal was assessed in 42 patients operated on the abdominal organs and lower limb arteries. The time of development of the analgesic effect and duration and depth of analgesia were compared. The drug effects were compared from protocols of clinical examination, hemodynamic changes, and time course of external respiration and blood saturation with oxygen. The findings confirm a high analgesic effect of ketanov, which is not inferior to tramal, and by some parameters even higher.