Treatment of pain in patients with mine blast wounds during treatment in military medical clinical centers

Abstract

Considering the war situation in Ukraine, the treatment of pain in patients with mine blast injuries is of great importance in today's medical practice because, during the Anti-Terrorist Operation/Joint Forces Operation, such injuries account for more than 25%, and chronic pain after such injuries is diagnosed in 83.3% of cases. Such injuries are characterized by significant damage. Data on pain treatment at the stage of treatment in military medical clinical centers are scarce.The goal of the work. To investigate the results of pain treatment of patients with mine blast wounds at the stage of treatment in military medical clinical centers of the Armed Forces of Ukraine.Methods. Data on the treatment of 280 patients with mine blast injuries are presented. Pain intensity was diagnosed using a visual analog scale. The Shapiro-Wilk test was used to check the distribution of quantitative indicators for normality. The distribution law differed from the normal one; the median value (Me) and the interquartile range (QI-QIII) were given to represent quantitative indicators. The comparison of indicators in two groups was carried out according to the Mann-Whitney test. To analyze the dynamics of the indicators, the Friedman test for related samples was used, the posterior comparison was carried out using the Bonferroni correction. For qualitative indicators, the absolute frequency of symptom manifestation and the relative frequency (%) are presented, and for the comparison of two groups, the chi-square test was used, taking into account the correction for continuity. When conducting the analysis in all cases, the critical significance level was equal to 0.05.Results. Pain intensity according to VAS before analgesia at the stage of treatment in military medical clinical centers shows that before analgesia in group 2 it was significantly higher than in patients of group 1 (p<0.001) and is 7 points – severe pain. Patients of group 1 experienced pain of average intensity on admission - 4 points. After analgesia, the average value of the VAS indicator in the two groups was practically not different, but it was statistically significant (p=0.012), this indicator was higher in group 2. During in-patient observation for 2-6 days (p<0.001) and before discharge from in-patient treatment (p=0.013) values of the VAS indicator in group 2 were higher than in group 1. The dynamics of the intervals between analgesia indicate that in groups 1 and 2 there is a statistically significant difference during the 1 day of observation (p=0.005) and 9-14 days of observation (p<0.001).Conclusions. Taking into account the obtained data, it is clear that the effectiveness of analgesia, both in the previous stages of treatment and during the transportation of patients, was at a low level. It is also worth noting that during discharge from inpatient treatment, patients still felt mild pain. Patients with mine blast injuries have a high risk of chronic pain. The obtained results of the study indicate ways to improve the results of treatment in this category of patients. Achieving good pain control in the early stages of treatment and maintaining continuity of care during evacuation can potentially reduce the frequency of chronic pain.