PECULIARITIES OF PAIN MANAGEMENT IN PATIENTS WITH GUNSHOT WOUNDS IN MEDICAL AND NURSING TEAMS

Abstract

Summary. During the Anti-Terrorist Operation/Joint Forces Operation in eastern Ukraine, gunshot wounds account for about 74% of the casualties. Such injuries are accompanied by high intensity pain. At the stage of treatment in medical and nursing teams, effective pain management is important, because in the long term, more than 70% of these patients suffer from chronic pain. Therefore, studying the features of pain management at this stage of treatment can play an important role in improving the results of their treatment.
 Objective. To study the peculiarities of pain treatment in patients after gunshot wounds at the stage of treatment in medical and nursing teams.
 Methods. Study of patients with gunshot and mine-blast wounds. A visual analog scale was used to study the intensity of pain. The results of the study were analyzed using the EZR v.1.35 package (R statistical software version 3.4.3, R Foundation for Statistical Computing, Vienna, Austria). The Shapiro-Wilk, Mann-Whitney, Friedman, and Bonferroni correction criteria were used.
 Results. The results of the study of 769 patients after gunshot wounds indicate that: 1) upon admission to the nursing teams (before anesthesia), the VAS pain intensity in group 1 was statistically different from group 2 (p<0.001) – in group 2, this indicator was higher; 2) the dynamics of VAS pain intensity during 2 days of observation shows no difference between the observation groups: 1 day – p=0.636, 2 days – p=0.465; 3) intervals between analgesia during the 1st day indicate a statistically significant difference between the groups (p=0.001), and on the 2nd day of observation no such difference was observed (p=0.818).
 Conclusion. At the time of admission to the medical and nursing team, the pain intensity according to the VAS was 7-8 points, which meets the criteria for high intensity. This intensity of pain is likely to affect the chronicization of pain in the future. The number of injured anatomical areas of the body is important for determining the tactics of pain treatment in patients with gunshot wounds, because the intervals between the administration of painkillers indicate that those patients who were injured in 3 or more anatomical areas of the body more often needed the administration of painkillers.