Osnovna načela liječenja boli u politraumi

master's thesis

• Title (english): Basic principles of pain management in polytrauma patients
• Author: Elora Pavla Matanović
• Mentor: Daniela Bandić Pavlović (mentor)
• Committee member: Mladen Perić (predsjednik povjerenstva)
• Committee member: DINKO TONKOVIĆ (član povjerenstva)
• Committee member: Daniela Bandić Pavlović (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Anaesthesiology, Resuscitation and Intensive Care in Surgical Specialities); Zagreb
• Defense date and country: 2017-07-14, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Anesthesiology and Reanimatology

Abstract

Bol se definira kao neugodan emocionalan i osjetni doživljaj povezan sa stvarnim ili potencijalnim oštećenjem tkiva ili opisan u kontekstu takvog oštećenja. Termin politrauma predstavlja teško ozlijeđenog bolesnika kod kojega istovremeno postoje teške ozljede najmanje dviju tjelesnih regija, pri čemu najmanje jedna ili kombinacija više njih može dovesti do smrtnog ishoda.
Neliječena bol također može pogoršati učinke traume na disanje, hemodinamsku stabilnost, renalnu i gastrointestinalnu funkciju te posljedično dovesti do razvoja komplikacija i povećane incidencije smrti. Loše liječena akutna bol u politraumi može dovesti do anatomskih i patofizioloških promjena u živčanom sustavu s posljedičnim razvojem kronične boli. Cilj liječenja boli u politraumi je smanjenje mortaliteta i morbiditeta, brže poboljšanje mobilnosti, sveopćeg zadovoljstva pacijenta i raniji otpust iz bolnice. Izuzetno je bitno obaviti temeljit pregled pacijenta te ustvrditi koja vrsta farmakološke terapije boli bi bila najprimjerenija. Pri određivanju adekvatne analgezije nužno je znati moguće nuspojave svih metoda liječenja boli kako bismo bolje mogli procijeniti njihovu učinkovitost. Suvremeno liječenje boli podrazumijeva korištenje balansirane multimodalne analgezije. U takvoj analgeziji koristi se nekoliko vrsta lijekova ili načina primjene lijekova kako bi se postigao maksimalni terapijski učinak uz smanjenje nuspojava liječenja. Primjeri takvog liječenja uključuju primjenu kombinacije lokalnog anestetika i opioida epiduralnim kateterom ili peroralno davanje NSAIL-a i istodobnu primjenu opioida PCA pumpom. Potrebna je redovita procjena stanja bolesnika, reevaluacija boli i prilagodba terapije. Brzo i pravilno liječenje boli dovodi do poboljšane kvalitete života bolesnika.

Abstract (english)

Pain is defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. The term polytrauma is defined as two or more severe injuries in at least two areas of the body. At least one out of two or more injuries or the sum total of all injuries can endanger the life of the injured person.
Poorly treated acute pain in polytrauma can lead to sever anatomical and physiological changes in the central nervous system and ultimately to the development of chronic pain. Untreated pain can worsen the effect of trauma on breathing, hemodynamic stability, renal and gastrointestinal function and finally it can lead to a higher incidence of complications and death. Lower morbidity and mortality rates, shorter hospital stay, earlier mobilization and better patient satisfaction are the main goal of pain management in polytraumatized patients. A thorough physical examination is extremely valuable in selecting the most appropriate pharmacological pain management method. While provision of adequate analgesia is vitally important, it is also necessary to acknowledge serious adverse effects of pain medications and weigh them against their benefits. Up to date pain management is centred around the use of multimodal analgesia techniques in which we use different classes of analgesics and different sites of analgesic administration in order to achieve topmost therapeutic effect with reduced analgesic related side effects. In multimodal analgesia, we may administer a combination of local anaesthetics and opioids epidurally or nonsteroidal anti-inflammatory drugs orally simultaneously with opioid analgesics administered by patient-controlled analgesia. Regular assessment of the patient and revision of the pain are necessary for adjusting the correct dosage of medication. Prompt and accurate pain management can lead to improved quality of patient’s life.

• Keywords: akutna bol; politrauma; liječenje boli; multimodalna analgezija
• Keywords (english): acute pain; polytrauma; pain management; multimodal analgesia
• Language: croatian
• URN:NBN: urn:nbn:hr:105:341300
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2017-11-23 13:19:14