Management of pain treatment in the early postoperative period. Practice of using ketorolac. A clinical case

Abstract

The current strategy of rational perioperative analgesia involves reducing the use of opioid analgesics and preventing associated side effects. Today it is known that the use of opioid analgesics can further lead to the development of hyperalgesia. Opioid-induced hyperalgesia is an adaptive response of the body in response to exogenous administration of opioids, the mechanisms of development of which are associated with the activation of the central glutamatergic system and the release of spinal dinorphins. In contrast, gabapentin, NSAIDs, and ketamine have opioid-preserving properties, reducing the number of opioid-associated side effects. Hyperalgesia is a condition that underlies the formation of chronic pain and develops regardless of the degree of postoperative wound repair.
 For the treatment of pain in the postoperative period, the main group of treatment agents are opioid analgesics, which are prescribed to 60% of patients. However, with severe pain, there is a need for opioids in doses that exceed the standard recommended. It is known that the tactics of increasing the dose of opioid analgesics leads to an increase in the frequency of adverse reactions: severe sedation, respiratory depression, nausea, vomiting, intestinal paresis, dysfunction of the biliary and urinary systems, hallucinations. In order to reduce side effects, the doctor reduces the dose of opioids, which is accompanied by inadequate analgesia.
 Given the above, clinicians prescribe additional drugs of other drug groups that can enhance the analgesic effect of opioids. An important aspect is the ability to reduce the dose of opioids.
 Our data and data of other authors. Until recently, NSAIDs were rarely used in intensive care units, mainly in mild to moderate pain.