Pain medicine 2019-06-20T14:29:15+03:00 Oleksandr Marchuk Open Journal Systems <p>"Medicina bolu" is a science-and-practice periodical for medical professionals. The main highlighting issue is pain, but not the only one, because in medicine there are no situations where a phenomenon is strictly isolated. Sign up for a print edition and follow up on the site to keep up with important and useful information.</p> <p>Thematic interests of the journal<br>Fundamental aspects of pain (clinical physiology, pathophysiology, pharmacology).<br>Applied aspects of pain (epidemiology, pain assessment, innovative methods of diagnosis and treatment, clinical pharmacology).<br>Clinical aspects of pain (acute pain, chronic pain, perioperative pain, posthumous pain, neuropathic pain, dysfunctional pain).<br>Clinical and anatomical approach to pain (headache, orofacial pain, neck and back pain, toothache, musculoskeletal pain, myofascial pain, fibromyalgia, visceral pain, pelvic pain, cardialgia, etc.).<br>Interdisciplinary approach to pain (in anesthesiology, in surgery, in pediatrics, neurology, vertebrology, in the clinic of internal diseases, oncology, rheumatology, gerontology, gastroenterology, traumatology and orthopedics, otorhinolaryngology, dentistry, obstetrics, gynecology and urology, in the palliative and hospice medicine).<br>Treatment and rehabilitation of patients suffering from pain (pharmacotherapy, physical rehabilitation, medical rehabilitation, alternative methods of treatment, means of psychological and psychotherapeutic influence, invasive methods of pain relief, organization of pain relief).<br>Separate clinical cases and their clinical examination.</p> The Difference Duration between Analgesia Bupivacaine Hyperbaric Morphine and Bupivacaine Hyperbaric Epinephrine Intrathecal toward Post Surgery of Sectio Caesaria Patient in Bhayangkara Mataram Hospital 2019-06-20T14:28:31+03:00 Erwin Kresnoadi <p><strong>Background and Objectives</strong>: The most used of regional anesthesia technic is spinal anesthesia. Spinal anesthesia is an easier technic to get the depth and speed of nerve blockade. Some medicine can be used as an adjuvant of local anesthesia to increase the effect of analgesia bupivacaine. This research is aimed to compare the effectiveness of administration of 0.1 mg intrathecal morphine and 0.1 mg intrathecal epinephrine to prolong 0.5% 12.5 mg hyperbaric analgesia bupivacaine toward caesarean section postoperative period. <br> <strong>Method:</strong> This research is an experimental clinical trial randomized double-blind phase II. Subject of this study is the elective surgery patients (ASA I and II) with spinal anesthesia who are 18–40 years old and having weight around 50–70 kgs. There are 48 patients that is divided into 2 groups; 24 patients of group M (morphine 0.1 mg) and 24 patients of group E (epinephrine 0.1 mg). <br> <strong>Result:</strong> The result of this study revealed the duration of analgesia is longer in group M (morphine 0.1 mg) than group T (tramadol 25 mg) (309.08±5.55 vs 221.66±6.43). <br> <strong>Conclusion: </strong>adjuvant of 0.1 mg morphine and 0.5% 12.5 mg intrathecal hyperbaric bupivacaine can make the work period of analgesia longer while post caesaria section surgery rather than 0.5% 12.5 mg bupivacaine and 0.1 intrathecal epinephrine.</p> 2019-04-29T00:00:00+03:00 Copyright (c) 2019 Experience in the local use of 0.25% bupivacaine for the treatment of postoperative pain 2019-06-04T15:08:57+03:00 Y N Babina V S Konoplitsky O O Kalinchuk D V Dmytriiev O A Nazarchuk E V Andriets <p>According to British scientists, about 300 million operations are performed around the world annually. They cause acute postoperative pain, the management of which is crucial for improving patient outcomes and reducing healthcare costs. Local anesthetic infiltration before closing the surgical incision is a commonly used technique in the operating room. This review focuses on the use of local anesthetic infiltration, 0.25% bupivacaine, into surgical incisions to reduce postoperative pain, as confirmed by an estimate of a reduction in the use of postoperative opioids and a visual analogue scale (VAS). The presented clinical cases and the combined analgesia scheme with infiltration of a local anesthetic into the postoperative wound were used to make it possible to argue about the effectiveness of anesthesia because on the peripheral mechanism of pain. Infiltration analgesia reduced the need for opioids and the time of stay in hospitals. It was concluded that there is a need for further research on methods of delivering anesthetics to postoperative wounds for pain management and improving the quality of treatment.</p> 2019-06-04T00:00:00+03:00 Copyright (c) 2019 Opioids in the treatment of non-specific acute and chronic pain 2019-06-04T15:08:57+03:00 D V Dmytriiev O A Zaletska D I Bortnik <p>After reading this article, the reader will be familiar with the general classes of opioid agonists and partial agonists, the basics of the pharmacokinetics and pharmacodynamics of opioids, the risks of opioid therapy and the requirements for the safe and effective use of opioids in acute and chronic pain. The use of opioids during surgical procedures or anesthesia is not discussed. Also, there is no discussion about various available opioid antagonists that are used to treat overdose and the various disorders associated with their use (including naloxone and naltrexone). Opioids are available, the most powerful and effective analgesics, and have become acceptable drugs for the treatment of acute and cancerous pain. However, there is concern about their use in case of chronic pain, if there is no cancer, because they are long-range ineffective but best suited for stopping this pain. Opioid prescription must be monitored for better use. Chronic pain creates discomfort for these patients, reducing their productivity and efficiency, which, in turn, can lead to economic problems in the country. The choice of Nalbuphine is due to the following reasons: the opioid, which is comparable to morphine by its analgesic potential, but has a better safety profile for nausea, vomiting and respiratory depression; not subject to strict quantitative accounting (extract on prescription form 1); the choice of opioid analgesics is significantly limited in Ukraine.</p> 2019-04-29T00:00:00+03:00 Copyright (c) 2019 Arsenal of regional blocks of urgent anesthetist in pediatric anesthesiology 2019-06-04T15:08:57+03:00 E O Glazov D V Dmytriiev <p>The main methods of regional analgesia in the practice of pediatric anesthesiologist are discussed in this article. Description of these methods is presented, including anatomy, sonoanatomy, and techniques for performing these regional blocks. The main indications for the use of different methods of regional anesthesia in the arsenal of pediatric anesthetist are considered. The main local anesthetics and their dosage are presented depending on the regional method.</p> 2019-06-04T00:00:00+03:00 Copyright (c) 2019 Gender aspects of the pain syndrome 2019-06-04T15:08:57+03:00 K O Ostrovska <p>In recent years, the subject of sex differences in the pain experience attracts a growing interest. The epidemiological and clinical data indicate that women have increased risk of chronic pain, and according to some sources, even experience more intense pain. <br> The hypothetical biological mechanisms underlying sex differences in pain perception consist in the modulating effects produced by sex hormones in relation to the neural substrate. This is confirmed by data on the distribution of gonadal hormones and their receptors in the areas of the peripheral and central nervous system that provide nociceptive transmission. <br> The complexity of the estradiol and progesterone effects on pain sensitivity lies in the fact that, according to various data, both have pre-nociceptive and antinociceptive effects, and testosterone appears to be more characterized by antinociceptive properties. The lion’s share of researches demonstrates the effect of a clinical pain exacerbation during the menstrual cycle. <br> There is irrefutable information about gender differences in responses to drug and non-drug pain treatment, although the results vary depending on a specific therapy and may depend on pain characteristics. Since the recommended dosage of a medication is often based on an “average” male weigh 70 kg, female patients may be facing the risk of increased therapeutic or adverse effects of a drug. The cause is in a higher average percentage of body fat, a lower mean body weight, which contributes to higher median drug concentrations compared with male patients. <br> At present, the available evidence does not allow adapting the methods of pain syndrome treatment to a gender. However, such innovations are quite possible and desirable in the foreseeable future. Additional studies will be required to clarify the mechanisms that determine sex differences in pain responses in order to provide adequate pain relief, according to the patient’s needs.</p> 2019-04-29T00:00:00+03:00 Copyright (c) 2019 Clinical case of postoperative anesthesia of a patient by using subanesthetic dose of ketamine in severe abdominal pathology 2019-06-20T14:29:15+03:00 B V Zaletskyi V A Korobko D V Dmytriiev <p>Pain is an inevitable consequence of surgical interventions in children, resulting in great stress and discomfort not only for patients but also for their parents. The intensity of the pain depends not only on the level of injury after the operation, but also on the localization and the nature of the procedure. Management of pain in children is best done through a multimodal approach: opioids, auxiliary drugs such as nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen, anti-neuroleptics such as gabapentin, and regional anesthetic methods. Postoperative anesthesia in abdominal surgery at present is a topical problem in anesthetic practice. In this clinical case, we would like to demonstrate the experience of applying post-operative anesthesia using subnormal dosages of ketamine. The patient was given anesthesia with prolonged infusion of a ketamine solution in a submorbid dose of 0.2 mg/kg/h IV. An assessment of the quality of anesthesia by assessing the level of stress markers, such as blood glucose, cortisol levels, and the assessment of the pain level on the NIPS scale was performed. <br> <strong>Conclusion:</strong> The use of a ketamine solution in a dose of 0.2 mg/kg/h has a positive effect on treating postoperative pain in patients after severe abdominal surgical interventions. Applying a ketamine solution in a dose of 0.2 mg/kg/h reduces tolerance of the patient to opioid analgesics and the development of hyperalgesia and allodynia.</p> 2019-06-04T00:00:00+03:00 Copyright (c) 2019