Kuchyn Y. Multimodal analgesia in multiple trauma patients in the early post-traumatic period, intraoperative and in the postoperative period

Determined frequency of intense pain in patients with combined injuries is as the following: preoperatively strong and unbearable pain is felt by 31%, during usual activity - 73% of the victims. Up to 32% of patients complain of severe and excruciating pain during transport to the operating room and preparation for surgery. During postoperative period, 90% of patients experience pain during everyday activities, rehabilitation, coughing and medical procedures. Established predictors of postoperative pain of high intensity in patients with combined trauma are the following: associated trauma with more than 3 segments involved (OR 24.5), multiple skeletal injury (OR 6.46), lack of planned anesthesia before surgery (OR 4.63) , delayed surgery (OR 3.29), numerous surgical interventions (OR 6.63) and the lack of planned anesthesia (OR 2.17), use of regional anesthesia reduces the risk of its development (OR 0.03). The use of regional anesthesia in patients with fractures of the clavicle and combined fractures of the ribs can reduce respiratory complications (OR of pneumonia - at 3.77 during general anesthesia) and reduces the need for respiratory support in those patients. The use of ultrasound to identify the nerve plexus in the regional anesthesia significantly reduces the time of the procedure and increases the probability of success (p<0.05). Substantiates the safety of postoperative start of thromboprophylaxis in patients with associated trauma. The concept of pain relief patients with multiple trauma is the constant control of pain with keeping it at a level that ensures physical and psychological comfort of the patient within the patient allowed to physical activity in posttraumatic and postoperative periods, and use the most safe and effective anesthesia during surgery. The algorithm of analgesia of patients with multiple trauma reducing the complications risk in the early posttraumatic period, during surgery and in the postoperative period.