Regional Anesthesia and Acute Pain ManagementRegional Anesthesia and Acute Pain ManagementРегионарная анестезия и лечение острой боли1993-65082687-1394Eco-Vector4281910.17816/RA42819ArticlesСтатьиResearch ArticleMultimodal analgesia in bariatric surgeryМультимодальная анальгезия в бариатрической хирургииNeimarkM. IНеймаркМ. ИKiselevRoman V.КиселевРоман Владимирович

MD, PhD, Department of anesthesiology and resustitation, Barnaul Railway Station Hospital

к.м.н., сотрудник отделения анестезиологии и реанимации «Областная клиническая больница на ст. Барнаул» ОАО «РЖД»

fincher-75@mail.ruAltay State Medical University, MH of RFГБОУ ВПО «Алтайский государственный медицинский университет» МЗ РФBarnaul Railways Station HospitalНУЗ «Областная клиническая больница на ст. Барнаул» ОАО «РЖД»15122016104VOL 10, NO4 (2016)ТОМ 10, №4 (2016)25426124082020Copyright ©; 2016, Eco-VectorCopyright ©; 2016, ООО "Эко-Вектор"2016Eco-VectorООО "Эко-Вектор"https://rjraap.com/1993-6508/article/view/42819

This review is devoted to the treatment of postoperative pain in bariatric surgery. At present, the prevalence of patients with a high degree of obesity is an epidemic that leads steadily growing number of bariatric operations. Showing the risk factors in the traditional approach to the use of opioids in these patients, as well as the consequences of inadequate analgesia in these patients. Details are presented modern pharmacological agents acting on different levels nociceptive system. Substantiates the role of a multi-modal approach to perioperative analgesia, mandatory use of regional anesthesia. The attention to the visualization neuroaxial structures using ultrasound in the context of the implementation of the efficacy and safety of regional anesthesia in patients with morbid obesity. Possible prospects for pain control in bariatric surgery.

Данный обзор посвящен проблеме лечения периоперационной боли в бариатрической хирургии. В настоящее время распространенность больных с высокой степенью ожирения носит характер эпидемии, что неуклонно приводит к росту числа операций по поводу ожирения. В статье показаны факторы риска при традиционном подходе с использованием наркотических анальгетиков у данной категории больных, а также последствия неадекватной анальгезии у этих пациентов. Подробно представлены современные фармакологические агенты, воздействующие на различные уровни ноцицептивной системы. Обоснована роль мультимодального подхода к периоперационному обезболиванию, обязательным применением регионарной анестезии. Акцентировано внимание к визуализации нейроаксиальных структур при помощи ультразвука в контексте эффективности и безопасности выполнения регионарной анестезии у больных с морбидным ожирением. Обсуждаются возможные перспективы контроля болевого синдрома в бариатрической хирургии.

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