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№4' 2015
ANESTHESIOLOGYInternational Medical Journal, Vol. 21., Iss. 4, 2015, P. 88−91.
THE CHOICE OF DRUGS FOR ANALGESIA IN GERIATRIC PATIENTS WITH POLYTRAUMA
Kharkiv National Medical University, Ukraine
The aim of the work was the search of effective drugs for postoperative analgesia in acute and early period of traumatic disease in geriatric patients for securing the most effective analgesia with the least negative clinical effects. The study involved 89 patients with multitrauma aged 66.16±3.81 with ISS 24.3±4.2, and severity of state by APACHE−II 15.2±4.4. The patients with brain injury were excluded. The common intensive care was done for all patients. The patients were divided into 3 statistically indistinguishable groups depending on the given analgesic. Group 1 (n = 28) was administered morphine (0.13±0.02 mg/kg every 46 hours), in group 2 (n = 30) nalbuphine (0.12±0.02 mg/kg every 46 hours), group 3 (n = 31) infulgan (1000 mg every 6 hours), if it was necessary nalbupfine was added. Intensity of pain by 100−point visual analog scale (VAS), daily dose of opiates, glycemia, cortisolemia, the concentration of IL−6, IL−8 were studied on admission, on day 1, 3, 7 and 14 day after surgery. On admission glycemia, cortisolemia, concentration of IL−6, IL−8 were in strong direct correlation with the level of ISS and APACHE−II (r ? 0.68±0.10), as well as the daily dose of opiates. The daily dose of morphine in group 1 decreased from 0.79±0.14 mg/kg on day 1 to 0.28±0.14 mg/kg on day 7, the dose of nalbuphine in group 2 −− from 0.87±0.15 to 0.32±0.10 mg/kg. On day 14 opiates were withdrawn. In group 3 the daily dose of nalbuphine decreased from 0.29±0.14 mg/kg on day 1 to 0.08±0.12 mg/kg on day 7, on day 14 opiates were withdrawn. Nalbuphine was required in group 3 in patients with maximal level by ISS and APACHE−II. The level of stress markers decreased in all groups, but in group 3 decreasing of levels of IL−6 and IL−8 were observed (from 14.91±4.51 and 92.3±21.7 pg/ml on day 1 to 8.21±1.35 and 70.2±16.1 pg/ml on day 14, respectively). In group 1 morphine side effects were observed, 16 patients had somnolence, 8 had nausea, 2 itching, 9 respiratory depression. Morphine, nalbuphine and infulgan have the same analgesic effectiveness postoperatively in elderly patients with multitrauma. At the same time morphine and nalbuphine do not eliminate the cause of pain, i. e. release of inflammatory mediators. Infulgan provides analgesia pathogenically by decreasing inflammatory mediator concentration in the blood.
Key words: pain syndrome, polytrauma, geriatric patients, morphine, Nalbuphine, Infulgan, interleukins.