ПабМЕд - это отлично, это лучше чем знакомый фармаколог
Я бы рекомендовал потихонечьку его осваивать. Профессиональный английский совсем не сложен. При поиске в Пабмеде по заданному Вам вопросу я бы использовал поисковые запросы acute postoperative pain и management of postoperative pain. Не забывайте, что в левой колонке есть фильтры. По началу более чем достаточно ориентироваться на систематические обзоры. То есть вбили нужный поисковый запрос - вышло тыща ссылок. Заходите в фильтры и ставите галку в чекбокс systematic review, а другие (если были) снимаете. Закрываете окно выбора фильтра и тыкаете в уже выбранный фильтр, то есть в systematic review, который в этой колонке появился. Из ранее найденных тыщи исследований останется намного меньше, наименования которых уже можно проглядеть "вручную". Приоритет - Кохрановским обзорам.
Есть более удобный и вполне надежный источник качественной информации - UpToDate. Это великая вещь, но его нет в свободном доступе. Вот цитата из него по устранению послеоперационной боли пероральными средствами:
Цитата:
POSTOPERATIVE ORAL ANALGESICS — A wide variety of oral pain medications are available for the treatment of acute pain.
Choices include:
Acetaminophen (325 to 1000 mg orally [or rectally] every four to six hours, to a maximum dose of 4 g/day)
Ibuprofen (300 to 800 mg orally three or four times per day)
Narcotics
Codeine 15 to 60 mg orally every four to six hours
Oxycodone 5 to 30 mg orally every four to six hours
Combination therapies such as Percocet (combinations of 325 to 650 mg acetaminophen /2.5 to 10 mg oxycodone , one or two tablets orally every four to six hours), Percodan (325 mg aspirin /4.5 mg oxycodone, one or two tablets orally every four to six hours), Tylenol #2 (300 mg acetaminophen/15 mg codeine , one to two tablets orally every four to six hours), Tylenol #3 (300 mg acetaminophen/ 30 mg codeine, one to two tablets orally every four to six hours).
Depending upon the severity of the pain, prior allergies, prior patient experience and tolerance of these medications (nausea, gastrointestinal upset, bleeding disorders), any of these oral medications can be prescribed and tailored to the needs of the individual.
A Cochrane review analyzed the data for single dose oral analgesics from 35 prior Cochrane Reviews treating about 45,000 participants for acute postoperative pain [ 100 ]. No drug was found to produce high levels of pain relief in all participants. In patients with acute moderate to severe pain, 70 percent achieved good pain relief with the best drugs and pain relief for the worst drugs occurred in about 30 percent of the patients. The percentage of patients treated with placebo who achieved at least 50 percent maximum pain relief over four to six hours ranged from 5 to 15 percent. The period over which pain was relieved varied from two hours to 20 hours. Drug/dose combinations with good (low) numbers needed to treat (NNT) for at least 50 percent maximum pain relief over four to six hours relative to placebo included [ 100 ]:
Ibuprofen 400 mg (NNT 2.5, 95% CI 2.4-2.6)
Diclofenac 50 mg (NNT 2.7, 95% CI 2.4-3.0)
Etoricoxib 120 mg (NNT 1.9, 95% CI 1.7-2.1)
Codeine 60 mg + paracetamol 1000 mg (NNT 2.2, 95% CI 1.8-2.9)
Celecoxib 400 mg (NNT 2.5, 95% CI 2.2-2.9)
Naproxen 500/550 mg (NNT 2.7; 95% CI 2.3-3.3)
A long duration of action (>8 hours) was noted for:
Etoricoxib 120 mg
Diflunisal 500 mg
Naproxen 500/550 mg
Celecoxib 400 mg
Oxycodone 10 mg plus paracetamol 650 mg
Oral nonsteroidal anti-inflammatory drugs — We suggest that pharmacological management of mild to moderate postoperative pain begin with a nonsteroidal anti-inflammatory drug (NSAID), unless there is a contraindication to these agents. Preoperative administration of oral NSAIDS prior to elective minor surgery reduces postoperative pain [ 15,76,83,101-103 ]. (See 'Preemptive analgesia' above.)
Commonly used oral NSAIDS that can be used for postoperative pain are ibuprofen , diclofenac , ketoprofen and paracetamol. If oral medication is not tolerated, rectal administration is an alternative route.
Choices include:
Acetaminophen (325 to 1000 mg orally [or rectally] every four to six hours, to a maximum dose of 4 g/day)
Ibuprofen (300 to 800 mg orally three or four times per day)
Narcotics
Codeine 15 to 60 mg orally every four to six hours
Oxycodone 5 to 30 mg orally every four to six hours
Combination therapies such as Percocet (combinations of 325 to 650 mg acetaminophen /2.5 to 10 mg oxycodone , one or two tablets orally every four to six hours), Percodan (325 mg aspirin /4.5 mg oxycodone, one or two tablets orally every four to six hours), Tylenol #2 (300 mg acetaminophen/15 mg codeine , one to two tablets orally every four to six hours), Tylenol #3 (300 mg acetaminophen/ 30 mg codeine, one to two tablets orally every four to six hours).
Depending upon the severity of the pain, prior allergies, prior patient experience and tolerance of these medications (nausea, gastrointestinal upset, bleeding disorders), any of these oral medications can be prescribed and tailored to the needs of the individual.
A Cochrane review analyzed the data for single dose oral analgesics from 35 prior Cochrane Reviews treating about 45,000 participants for acute postoperative pain [ 100 ]. No drug was found to produce high levels of pain relief in all participants. In patients with acute moderate to severe pain, 70 percent achieved good pain relief with the best drugs and pain relief for the worst drugs occurred in about 30 percent of the patients. The percentage of patients treated with placebo who achieved at least 50 percent maximum pain relief over four to six hours ranged from 5 to 15 percent. The period over which pain was relieved varied from two hours to 20 hours. Drug/dose combinations with good (low) numbers needed to treat (NNT) for at least 50 percent maximum pain relief over four to six hours relative to placebo included [ 100 ]:
Ibuprofen 400 mg (NNT 2.5, 95% CI 2.4-2.6)
Diclofenac 50 mg (NNT 2.7, 95% CI 2.4-3.0)
Etoricoxib 120 mg (NNT 1.9, 95% CI 1.7-2.1)
Codeine 60 mg + paracetamol 1000 mg (NNT 2.2, 95% CI 1.8-2.9)
Celecoxib 400 mg (NNT 2.5, 95% CI 2.2-2.9)
Naproxen 500/550 mg (NNT 2.7; 95% CI 2.3-3.3)
A long duration of action (>8 hours) was noted for:
Etoricoxib 120 mg
Diflunisal 500 mg
Naproxen 500/550 mg
Celecoxib 400 mg
Oxycodone 10 mg plus paracetamol 650 mg
Oral nonsteroidal anti-inflammatory drugs — We suggest that pharmacological management of mild to moderate postoperative pain begin with a nonsteroidal anti-inflammatory drug (NSAID), unless there is a contraindication to these agents. Preoperative administration of oral NSAIDS prior to elective minor surgery reduces postoperative pain [ 15,76,83,101-103 ]. (See 'Preemptive analgesia' above.)
Commonly used oral NSAIDS that can be used for postoperative pain are ibuprofen , diclofenac , ketoprofen and paracetamol. If oral medication is not tolerated, rectal administration is an alternative route.
Кстати, возможный прием - предоперационное применение НПВС с целью сниженияя уровня послеоперационной боли и потребности в анальгетиках ("упреждающая анестезия", preemptive analgesia):
Цитата:
For preemptive analgesia, we use ibuprofen 800 mg (orally), ketorolac 30 mg (intravenously), or gabapentin 600 mg (orally). COX-2 inhibitors are also gaining acceptance for preemptive analgesia but have precautions for their use. (See 'Oral nonsteroidal anti-inflammatory drugs' below and 'COX-2 inhibitors' below.)
Trials with clonidine , ketorolac and ibuprofen have demonstrated decreased postoperative narcotic requirements.
Trials with clonidine , ketorolac and ibuprofen have demonstrated decreased postoperative narcotic requirements.
Вы писали:
Цитата:
Насчет склеротерапии - извиняюсь,я имел в виду эхосклеротерапию(допустим крупных притоков), после которой, иногда, пациенты отмечают болезненные ощущения,"Тянущие боли".
Извиняться не за что, я имел ввиду склеротерапию вообще - в том числе и ЭХО. Ни разу не сталкивался с необходимостью назначения обезболивающих при отсутствии осложнений. Если флебит - тогда да, наверное.
Из НПВС я в общем и целом предпочитаю ибупрофен европейских производителей (Нурофен, например) для любых целей, которые требуют применения НПВС в нашей практике и в быту.
