Military actions are a strong psychosocial stressor which affects all society layers [5, 11, 17] and, firstly, the military actions participants [18, 32]. Post-military crisis may lead to a post-traumatic stress disorder (PTSD) [1, 3, 4, 19, 23, 26, 29, 30]. According to the WHO, 16.2 % of the world population suffer from the war consequences, the relatives of 12.5 % people were injured in military actions [15, 25]. The PTSD are a direct cause of psychic disadaptation in 80% of the injured combatants[7, 12, 28], and their remote post-recovery period is often characterized by self-destructing behaviour, suicide attempts, drug and alcohol abuse, and other negative events [2, 14, 16, 20, 24, 31]. A broad spectrum of psycho-pharmacological and psychotherapeutical interventions for the PTSD treatment has been described by various authors, though, the data on their effectiveness are ambiguous [19, 27, 34, 35]. The traumas and somatic diseases of the PTSD patients sum up their negative action [6, 8, 13]. The frequency of the gunshot injuries makes up 54-70% of war injuries. According to the Military Forces of Ukraine Authorities, the structure of the gunshot injuries is represented as follows: 64% – injuries of the extremities: with 35.7% of the upper extremities injuries, and – 64.3% of the lower ones. From them 74.8% – are the soft tissues injuries, 25.2% – gunshot fractures. Bone defects are reported in 11.6% of the patients, and the patients who need further reconstructive operations represent 35-40% [9, 10, 21]. Despite the progress in the PTSD treatment, the aspects of psychocorrection and psychoprophylaxis within the psychosocial rehabilitation of the injured still stay the least studied [6, 22, 33]. The subjective feelings and emotions of the patients, resulting from their military injuries are in 100% of cases characterized by the PTSD development. So, through the PTSD prism, the anaesthetic support of such patients has its own peculiarities. As in 82.1% of cases positive treatment outcome is hard to achieve, the data of the study may be significant for treatment of these patients. It was mentioned before that the basis for the PTSD development is direct participation of the combatants in military actions [1, 3, 4, 19, 23, 26, 29, 30]. The study has shown that if a combatant was injured in military actions, his emotional and subjective feelings always result in the PTSD development. Also, the other scientists [2, 14, 16, 20, 24, 31] state, that the negative PTSD treatment remote outcomes may be observed in 80% of combatants. According to our study results, in 82.1% of cases, positive treatment outcome of the PTSD in injured combatants has not been achieved. This necessitated a thorough study of this problem. The presented data of the authors [19, 27, 34, 35] on effectiveness of psychopharmacological and psychotherapeutical intervention are questionable. The injuries and somatic disease in the PTSD patients join their negative effects [6, 8, 13]. Thus, detection of the PTSD negative treatment outcome predictors will improve the therapy effectiveness for such patients.
The purpose of the study was to improve the treatment effectiveness of patients with the gunshot extremity injuries and post-traumatic stress disorder by specification of the anaesthetic management during reconstructive operations. The following tasks were defined, according to the study purpose:
1. To study the peculiarities of the pain syndrome in patients with the gunshot injuries of the extremities and post-traumatic stress disorder.
2. To study the peculiarities of the development of the posttraumatic stress disorders, depending on the reconstructive operative interventions and anesthesiological support.
3. To study the predictors of the negative treatment outcomes in patients with the gunshot injuries of the extremities and posttraumatic stress disorder, having analysed the high-intensity pain diagnostic data, as well as the negative dynamics of the posttraumatic stress disorders.
4. To study the effect of the initial condition of the posttraumatic stress disorder on the pain syndrome.
5. To study the effect of the anaesthetic management on the final treatment outcomes of patients with the gunshot injuries of the extremities and posttraumatic stress disorder.
6. To justify the concept of perioperative pain management of the patients with the gunshot injuries of the extremities and the posttraumatic stress disorder.
