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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.

A retrospective descriptive nonrandomized cohort study of 585 anesthesia cards of patients who had undergone planned laparoscopic cholecystectomy showed no effect of the patient age and sex on the length of post-anesthetic rehabilitation period. The doses of sodium thiopental, ketamine, and trimeperidine affect the length of these periods by no more than 12%. Further search for and studying of factors affecting the duration of post-anesthetic rehabilitation is required in order to improve the safety and adequacy of general anesthesia.

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.

A prospective, randomized, comparative study was conducted. 3 analgesia protocols were used: 1) patient controlled analgesia (PCA) with trimeperidine in combination with a nefopam constant infusion; 2) PCA with trimeperidine in combination with a nefopam bolus; 3) PCA with trimeperidine separately during early postoperative period in cardiac surgery patients. The study included 60 patients agedf rom 40 to 65 years of age (20 patients in each group). The analgesia efficacy was evaluated with a 5-point verbal rating scale (VRS) for pain intensity and inspiratory lung capacity (ILC), measured with incentive spirometer. The safety of nefopam during early postoperative period in cardiac surgery patients was shown. The combination of nefopam and trimeperidine led to a more pronounced analgetic effect. Trimeperidine consumption was significantly lower in nefopam groups than in the group of isolated PCA. Wholly adverse effects were associated with trimeperidine and were dose-related The incidence of nausea, vomiting, dizziness, weakness, bowel paresis was significantly higher in isolated PCA group than in the other two groups.

In patients, undergoing laparoscopy cholecystectomy, two phenotype categories were identified on the basis of the total oxidative hepatic capacity determined by antipyrine test, which differed by duration of post-anesthesia rehabilitation. The potential of antipyrine phenotyping for individualisation of anesthetics' dosing is discussed.

Efficacy of systemic application of opiates (promedol) for the pain relief after big open abdominal operations, using visual-analogue scale (VAS), was estimated in 50 patients. During 36-48 h postoperatively analgesia was inadequate (VAS in a rest state more than 3 points and while movement--more than 4 points). Intensive pain (VAS 6 points and more) was noted in 58% of patients, while they are moving, and in 26%--in a rest state. Inadequate anesthesia may constitute one of causes of excessive systemic inflammatory reaction development in patients postoperatively.

The analysis of publications is devoted to the application of skin conductance monitoring in anesthesiology and intensive care. Rates of skin conductance (baseline values, the amplitude and frequency of the waves) are closely linked with the state of the sympathic nervous system. According to their dynamics it is possible to judge on the pain and stress in patients with whom the contact is difficult: newborns, infants, patients of all age groups during general anesthesia and in critical condition. According to published data monitoring skin conductance showed itself as a sensitive and promising method to identify and determine the severity of pain in all age groups, approaching by its characteristics the theses of the pain assessment perfect tool.

Introduction: A pilot unicenter blind placebo-controlled study comparing different analgesics was conducted in parallel groups, by concurrently using two patient-controlled analgesia (PCA) apparatuses in one patient, was conducted Subjects and methods. The study included patients after laparotomy. Group I patients (n=22) were proposed 2 PCA apparati, one of which contained trimeperidine solution and the other did placebo. Group 2 patients (n=17) were proposed 2 PCA apparatuses, one of which contained trimeperidine solution and the other did lornoxycam. PCA was adjusted in the same manner in both apparati. The patients were asked to determine which analgesic is best in providing 24-hour analgesia., Results: There were no differences in the intensity of pain between the groups. The latter did not differ in the number of adverse reactions. Comparison showed no significant differences in the use of trimeperidine between Groups 1 and 2 patients. Among Group 1 patients, 61% considered trimeperidine as the best analgesic and 22% did placebo; 17% called none. Group 2 patients chose trimeperidine in 41% of cases and lornoxycam in 41%, none was called in 18%., Conclusion: Comparative assessment of analgesics, by employing 2 PCA apparatuses in one patient, allows evaluation of the efficacy of analgesics added to the conventional methods.

The study was to evaluate the analgesic and opioid-sparing effect of intravenous paracetamol injections in cardiosurgical patients in the early postoperative period. Adequate analgesia within the first 12-18 hours of the early postoperative period is very important for a good prognosis of the further course of pain syndrome and for the reduction of a risk for its progression to its chronic form. In early studies, propacetamol lowered morphine use after orthopedic and gynecological operations. The efficacy of paracetamol used in cardiac surgery has been little studied and the results of the studies are conflicting. The randomized, blind, placebo-controlled study included patients after aortocoronary bypass surgery, of them 22 patients received paracetamol and 23 had placebo. The test drug (perfalgan 100 ml or placebo) was intravenously injected 30 min before extubation and then every 6 hours within succeeding 18 hours. The intensity of the pain syndrome was rated by a 5-score verbal scale every 2 hours. With pain score of 2 or more, promedol was intramuscularly administered in a dose of 10 mg. Inspiratory volume was recorded before extubation and the first administration of a drug just after extubation and then every 2 hours. The baseline indices did not differ in both groups. Throughout the observation, the inspiratory volume was lower in the paracetamol group than in the placebo group; however, there was a statistically significant difference (p = 0.012) in the reduction in the manifestations of the pain syndrome (by 81%) only just after tracheal extubation. During this period, inspiratory volume values were higher in the paracetamol group; however, a statistically significant (39%) difference between the groups in the mean values was obtained only during and 2 hours after extubation. In the perfalgan group, the mean total use of promedol was 36% less than in the placebo-group, which was statistically significant (p = 0.019). The early postoperative use of paracetamol after myocardial revascularization reduces the intake of opioids and diminishes the intensity of the pain syndrome within the first hours after extubation, which promotes a higher thoracic excursion, as confirmed by a statistically significant increase in the maximum inspiratory capacity.

The authors have compared various modes of spontaneous labor. Prolonged epidural infusion of naropine in combination with fentanyl has been found to cause a less motor block and therefore it may be used in the late first-to-second period of labor. Adequate analgesia ensures a smooth course of the second labor period and promotes the reduction in its duration and the correction of central hemodynamic and hormonal homeostastic disorders. The administration of moradol provides adequate analgesia of the first labor period, prevention, and elimination of abnormal labor activity, without exerting a depressive effect on maternal and neonatal respiration, which makes it possible to consider this procedure as an alternative mode of labor pain relief if there are contraindications to epidural analgesia.

Aim: To compare quality of anesthesia with opioid drug and nonsteroid anti-inflammatory drugs in 123 patients after extensive operative interventions of the lungs and trachea, abdominal organs, lower limbs., Material and Methods: Patients of group 1 took lornoxicam for relief of postoperative pain syndrome, those of group 2--promedol. Quality of anesthesia was assessed by visual-analogue and verbal scales, day dose of analgetic drug, administration of promedol, side effects incidence., Results: Lornoxicam in a dose 8 mg intravenously has comparable with 20 mg promedol analgetic effect. This justifies its use as a basic analgetic for treatment of acute pain after extensive surgery. Lornoxicam allows surgeons to do without opioids in 10-45% patients or to reduce their dose by 32-65%., Conclusion: Adequate anesthesia with lornoxicam and promedol early after surgery on the chest and abdominal organs, major vessels of the lower limbs occurs in 82 and 87% patients, respectively. Lornoxicam administration as continuous intravenous infusion and controlled analgesia in older patients eliminates the need in opioid analgetics in 45% cases and is well tolerated.

Proarrhythmogenic and antiarrhythmic effects of drugs for neuroleptanalgesia (NLA), ataralgesic (ATA) and antidepranalgesia (ADA) in chronic experiments on sleepless rabbits with acute myocardial infarction, with and without tachyarrhythmias, were studied using ECG, intraventricular electromanometry and tetropolar rheography. NLA (phentanylum, 1 microg/kg + droperidol, 5 microg/kg), ADA (pyrazidole, 1 mg/kg + tramal, 1 mg/kg) and ATA (diazepam, 1 mg/kg + promedol 0.5 mg/kg) produce antiarrhythmic effect with maximum manifestation of NLA on the 3rd day, and of ATA and ADA on 3-5th day. This medication increased blood supply and contractility of ischemic myocardium. Proarrhythmogenic effects of this medication were not observed.

Continuous intravenous infusion of promedol, 0.1 mg/kg, with additional boluses, 0.5 mg/kg, was used as postoperative analgesia in 20 newborns. Fifteen (25%) children were operated for congenital gastrointestinal defects or peritonitis, 2 children (10%)--for chylothorax, and tumor was eradicated in 3 (15%) children. On the basis of behavioral reactions, physiological indices (cardiac rate, arterial pressure, SpO2, and respiration rate/artificial pulmonary ventilation--APL) as well as of laboratory "stress" tests (blood glucose and cortisol and acid-base balance) it was proven that analgesia with continuous intravenous promedol infusion was effective. It was shown as possible to administer the promedol infusion in newborns while switching them from APL to independent breathing until the spontaneous breathing with constant positive pressure is ensured provided the pO2, pCO2 and SpO2 respiration indices are satisfactory.

We used lornoxicam (n = 16) and ketorolac (n = 20) to study the possibilities of applying the non-steroid anti-inflammatory drugs within the postoperative patient-controllable analgesia (PCA). With respect to a used analgetic, the frequency rate of good PCA anesthetic results was found, on day 1, to be 60-77%. The good anesthetic results were registered in 25% of patients when the routine scheme was in use. Non-steroid anti-inflammatory agents (lornoxicam, ketorolac) can be prescribed within the early postoperative PCA as basic analgetics, which essentially reduces the need in promedol without worsening the analgesia efficiency.

The efficiency and safety of postoperative use of propacetamol was estimated in 30 patients by means of double blind placebo controlled method. The first group consisted of 15 patients to whom propacetamol was introduced intravenously in single dose of 2 g along with patient controlled anesthesia with promedol. Placebo in combination with patient control anesthesia were used in 15 patients from the 2nd group. Intravenous introducing of propacetamol in dose of 2 g in 15 minutes provides relief of pain intensity in postoperative period. So it permits to consider propacetamol as basic non-opioid analgesic. In early postoperative period combination of propacetamol and opioid analgesic (promedol) reduces demands in the latter by 44%.

Lornoxicam was used for analgesia in 64 patients on days 1-2 after extensive interventions. The drug efficiency and safety were evaluated depending on the dose and route of administration. Intravenous infusion of lornoxicam in a daily dose of 24 mg (basic therapy) did not involve the use of opioids in 35% patients and its analgesic effect was higher than that of promedol monotherapy. Combined therapy with lornoxicam and promedol allows reduction of promedol dose by 25-50% and the incidence of untoward effects by 27-44%.

Portocaval shunting reliably preventing hemorrhages from esophagogastric veins is most often used in surgery for extrahepatic portal hypertension (EPH) in children. Difficulties of anesthesia for this intervention consists in essential alteration of volume bloodflow as a result of massive outflow of deposited blood to systemic circulation through the new bypass. This necessitates search for an adequate method of general anesthesia and variants of infusion therapy for surgical venous shunting in children with EPH. Sixty-eight children aged 1-15 years with the EPH syndrome were subjected to elective surgery under general analgesia (multicomponent balanced neuroanesthesia with evaluation of some hemodynamic and metabolic parameters). The proposed protocol of general anesthesia in combination with epidural analgesia by local anesthetics and promedole and infusion therapy in the hypervolemic hemodilution mode create the most favorable conditions for adaptation of hemodynamics to increased preloand.

Analysis of many-year experience gained in the use of a variety of methods and means for treating the painful syndrome in victims and patients after planned and urgent surgery allowed the authors to determine the optimal approaches to postoperative analgesia. Special attention is paid to introduction of new drugs and methods of analgesia with differentiated approach to prevention and treatment of the painful syndrome. A conclusion on the necessity of pathogenetically based and strictly individual postoperative analgesia is made; such analgesia is often to be multilevel and multicomponent, with consideration for the complex origin of painful reaction (including the components of the painful syndrome) and the armory of available means.

The study was conducted on experimental models of pain sense induced in mice by exposure to thermic or chemical factors and in rats by exposure to electric factors. Nitrosorbide and no-spa possess a dose-dependent analgesic effect. Both drugs excelled analgin in the intensity and duration of analgesic effect.

Experiments on rats with skull inquiry show that biculline (dose 2 mg/kg) removes antiedematous effect of fenibut (50 mg/kg), sodium hydroxybutirate (200 mg/kg), promedol (1 mg/kg), and synthetic analogs of encephalines DAGO and DSLET (100 mg/kg). Naloxon at a dose 1 mg/kg blocks antiedematous effect of ligands of opiate receptors, but does not change the effect of fenibut and sodium hydroxybutirate. The presence of close inter-regulatory interactions between GAMK-ergic and opioidergic systems in forming the traumatic correction is suggested.

Efficacies of two methods of nondrug analgesia: acupuncture (1000 cases) and antipain transcutaneous electroneurostimulation (91 cases), as well as of narcotic analgesics omnopon and promedol (229 cases) were compared in the immediate and early postoperative period. In 229 cases acupuncture was used for the treatment of other functional complications of the postoperative period. The efficacies of the methods in question were assessed by formalized verbal estimation scales. Narcotic analgesics provided adequate analgesia in 75 to 79% of patients, electrostimulation in 61 to 64%, acupuncture in 50% of patients. Acupuncture, though less effective than narcotic analgesics, helped arrest or noticeably alleviate the severity of such postoperative complications as reflex retention of the urine, impairment of hte drainage function of the bronchi, intestinal paresis, bronchial asthma, vomiting, nausea, pain or itching in the stoma, chill, hyperthermia in 43 to 81% of cases. The authors come to a conclusion on the desirability of an integrative approach (combined use of drugs and nondrug methods of analgesia) in the management of postoperative pain.

Prosidol, a new Russian narcotic analgesic, was used in various dosage forms (buccal and oral tablets, injection solution) in 113 cancer patients for the treatment of chronic pain, as a component of total anesthesia, and for postoperative analgesia. The best results were attained with the universal noninvasive dosage form, buccal tablets, used for the treatment of chronic pain in incurable patients. Analgesic properties of buccal prosidol are close to those of tramadol, the drug is well tolerated by the patients and causes no grave side effects. As a drug for postoperative analgesia prosidol was highly effective in patients after extracavitary oncologic surgery and less effective after thoracal and abdominal interventions. As a component of total anesthesia prosidol is inferior to fentanyl and approximately similar to promedol. An advantage of prosidol is its highly effective universal noninvasive dosage form, buccal tablets, which may be used for rapid analgesia in any situation.

With radiation injury caused by superlethal doses of 150 Gy the analgesic effect of narcotic drugs decreases and the level of drug analgesia depends on the initial status of nociceptive reactions. The role of mu-opiate mechanisms in the development of postirradiation analgesia to thermal stimuli has been determined.

Coordination compounds of methenkephalin with transition metals: copper, cobalt, nickel and zinc were shown to be superior to morphine by the analgesic activity and to morphine and methenkephalin by the duration of the analgesic effect. A more stable relationship between opiate receptors and copper-containing methenkephalin was shown in the experiments on the isolated neuronal membrane.

The tranquilizer mebicar produces an antishock action, normalizes different links of mediator, acid-base and oxygen homeostasis. Mebicar decreases arterial pressure and the tone of peripheral vessels insignificantly and for a short period.

A comprehensive approach is suggested to the assessment of the analgetic action of analgetics during screening. This approach lies in the study of the drug effects on the emotional, vegetative and motor manifestations of the painful reactions. Based on multiple and regression analysis the role of different factors of the initial status of the body in the development of analgesia is demonstrated. Application of the given approach is examplified by the reference analgetic promedol.

Treatment with such analgetics as analginum, promedol and pantopon was shown experimentally either to inhibit or to stimulate the growth of sarcoma-37 and its dissemination. It was also found to reduce the tumor growth--stimulating effect of operative trauma.

In chronic experiments on conscious rats analgesic and autonomic-corrective effects of clopheline in cardiogenic pain were demonstrated. The drug was also shown to decrease emotional and motor manifestations and to stabilize central hemodynamics in patients with acute myocardial infarction.