Strogush O. Optimization of multimodal analgesia after orthopedic and traumatological surgical interventions in the lower extremities.

The dissertation is devoted to the actual problem - improving the treatment of postoperative pain in orthopedic and traumatological patients who were underwent an operation of the lower extremities under spinal anesthesia by introducing multimodal analgesia as a combination of drugs from different classes using the technique of preventive analgesia, strategies of antihyperalgesia in perioperative period. As a result of the investigation conducted in 75 patients, data of the effective treatment of pain syndrome were obtained in the early postoperative period using different options of multimodal analgesia: 1) analgesia "at demand" with ketorolac and omnopon; 2) preventive analgesia with peroral clonidine in combination with ketorolac by the scheme "at demand"; 3) preventive analgesia with peroral nimesulide (against a background of intraoperative spinal anesthesia with lidocaine), and 1) preventive analgesia consisting of buprenorphine (for premedication), peroral clonidine, dexketoprofen, and paracetamol; 2) preventive analgesia including buprenorphine, mirtazapine, dexketoprofen, and paracetamol (against a background of intraoperative spinal anesthesia with bupivacaine and lidocaine). Characteristic signs of preoperative distress, changes in indices of endocrine-metabolic response , the degree of sedation, the sleep disorders in the perioperative period were shown, and the quality of life in the postoperative period against a background of the various techniques of analgesia was assessed. Multimodal analgesia consisting of buprenorphine, clonidine, dexketoprofen and paracetamol is the most effective in preventing and treating pain in this category of patients. The influence of neuroticism, as typological characteristic of the patient personality, on forming an assessment of pain was determined.