Regional Anesthesia and Acute Pain ManagementRegional Anesthesia and Acute Pain ManagementРегионарная анестезия и лечение острой боли1993-65082687-1394Eco-Vector4281110.17816/RA42811ArticlesСтатьиResearch ArticleThe modern state of analgesia after total hip replacementСовременное состояние проблемы послеоперационного обезболивания при тотальном эндопротезировании тазобедренного суставаTimerbaevV. HТимербаевВ. Хinfo@eco-vector.comDolgashevaN. SДолгашеваН. Сinfo@eco-vector.comGenovPavel G.ГеновПавел Геннадьевич

MD, PhD, The Head of Subdivision of Pain Management, Department of Anaesthesiology, N.V. Sklifosovsky Scientific Research Institute for Emergency Medicine

к.м.н., заведующий сектором изучения проблем профилактики и лечения острых и хронических болевых синдромов отделения анестезиологии ГБУЗ «НИИ скорой помощи им. Н.В. Склифосовского Департамента здравоохранения г. Москвы»

genov78@yandex.ruN.V. Sklifosovsky Scientific Research Institute for Emergency MedicineГБУЗ «НИИ скорой помощи им. Н.В. Склифосовского Департамента здравоохранения г. Москвы»15122016104VOL 10, NO4 (2016)ТОМ 10, №4 (2016)23124224082020Copyright ©; 2016, Eco-VectorCopyright ©; 2016, ООО "Эко-Вектор"2016Eco-VectorООО "Эко-Вектор"https://rjraap.com/1993-6508/article/view/42811

Total hip replacement is an important orthopedic surgery allowing to increase high-activity profile and longevity of the elderly patients suffered from arthritis and proximal hip fracture. For the good outcome of the surgery we have to use enhanced recovery strategy which in turn needs performing adequate postoperative analgesia. Using painkillers only (per os, i.v., i.m., s.c.) after THR is not enough to reach this aim (well pain relief at rest and during movement) due to low analgesic potency of the non-opioid drugs and adverse reactions related to opioids, so, the regional analgesia methods are widely spread. Considered before as a «gold standard» epidural analgesia method is not quite suitable for the aged patients as so as the sympathetic and motor blocks hinder an enhanced recovery after THR. In recent decades the interest in peripheral regional analgesia methods has been gradually increasing. Fascia iliaca and psoas compartment blocks, local wound infiltration analgesia are getting the modern regional THR postoperative analgesia armamentarium. Each of them has some benefits and pitfalls and only face-to-face comparisons within the scope of clinical trials will give us the basic for the constituting the local and national post-THR analgesia guidelines.

Протезирование тазобедренного сустава в современном мире - важнейшее ортопедическое вмешательство, позволяющее продлить активное долголетие и даже жизнь пожилым людям, страдающим коксартрозом или имеющим перелом проксимального отдела бедра. Для получения оптимальных результатов хирургического лечения крайне важным является раннее начало восстановительного лечения, которое в свою очередь невозможно без организации адекватного периоперационного обезболивания. Применение лишь системных (таблетированных, для в/в, в/м и подкожного применения) анальгетиков не позволяет решить задачу обеспечения полноценного (купирование статической и динамической боли) обезболивания после ТЭПТС из-за ограниченного анальгетического потенциала неопиоидных препаратов, а также развития побочных эффектов опиоидов, поэтому актуальным является применение методов регионарной анестезии. Ранее считавшийся для ТЭПТС золотым стандартом регионарной анестезии метод эпидуральной анальгезии не вполне подходит для пациентов пожилого и старческого возрастов в связи со сложностью (на фоне симпатической, а порой и моторной блокады) обеспечения ранней мобилизации и начала восстановительного лечения после операции. В последние десятилетия повысился интерес к периферическим методам регионарного обезболивания. Подвздошно-фасциальный блок, инфильтрация сустава большими объемами анальгетиков и блокада нервов поясничного сплетения представляют собой палитру регионарной анестезии и анальгезии при ТЭПТС. Каждый из этих методов имеет свои преимущества и недостатки, и только непосредственное их сравнение в рамках клинических исследований позволит расставить приоритеты и создать локальные и национальные госпитальные протоколы периоперационного обезболивания.

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