Effectiveness of the Infulgan with Reumoxicam Combination for Postoperative Analgesia in Gerontologic Patients with Polytrauma

The purpose of the work was to determine the effectiveness of the infulgan with reumoxicam combination for postoperative analgesia in gerontologic patients with polytrauma. Materials and methods. We examined 32 patients over the age of 60 with a skeletal polytrauma who received as a postoperative analgesic combination of a central cyclooxygenase inhibitor (COG) infulgan with a peripheral COG inhibitor reumoxicam. The study was conducted on 1st, 3rd, 5th and 7th days after surgery. The level of pain by the visual analog scale (VAS), the concentration of stress markers, the mediators of the systemic inflammatory response (SIR), and the parameters of the system of regulation of the aggregate state of the blood (RASB) were determined. We took into account the daily need for analgesics, the frequency of their administration, the side effects of drugs for anesthesia, and the duration of effective analgesia. Results and discussion. It was discovered, that the need for opiates was low if analgesia was used. The observed side effects were related to the use of nalbuphine and were noted only in 2 (6.3%) patients: on the 1st day there was drowsiness and nausea. On the 3rd day these patients had only drowsiness. There were no side effects associated with analgesia in the rest of patients. The dynamics of the level of markers of stress (glucose and cortisol) was sufficient enough to suggest an equal analgesic effect of the combination of COG inhibitors and opiate analgesics. A significant decrease in the levels of these mediators was recorded after the 1st day of the postoperative period, and by the end of the study, they reached the normal level. On the background of COG inhibitor therapy, on the 1st day after the operation, the tendency to hypercoagulation did not increase, but, starting from the 3rd day, this trend significantly decreased, practically disappearing after the 5th day. Conclusions. Thus, the need for only small doses of opiates during the first 3 days after surgery, the decrease in the concentration of stress markers and a significant decrease in the manifestations of SIR show a high analgesic activity of the combination of COG-2 and COG-3inhibitors, the basis which is a pathogenetically determined influence on the mechanisms of SIR.