MD-OncoMD-OncoMD-Onco2782-32022782-6171Publishing House ABV Press6210.17650/2782-3202-2023-3-1-38-47NEW APPROACHES AND SUCCESSES IN TREATMENT OF ONCOLOGICAL PATIENTS AT THE CURRENT STAGEНОВЫЕ НАПРАВЛЕНИЯ И УСПЕХИ В ЛЕЧЕНИИ ОНКОЛОГИЧЕСКИХ БОЛЬНЫХ НА СОВРЕМЕННОМ ЭТАПЕPerioperative pain management in opioid-dependent patient with chronic pain: Current approaches and hidden dangers. Clinical caseПериоперационное обезболивание у опиоидзависимого пациента с хронической болью: современные подходы и подводные камни. Описание клинического случаяhttps://orcid.org/0000-0002-9454-0002GruzdevV. E.ГруздевВ. Е.
Russian Federation

Vadim Evgenyevich Gruzdev

111 1st Uspenskoe Shosse, Lapino, Moscow region 143081

Вадим Евгеньевич Груздев

143081 Московская обл., д. Лапино, 1-е Успенское шоссе, 111

vadimgru@yandex.ruhttps://orcid.org/0000-0002-4484-6716AnisimovM. A.АнисимовМ. А.
Russian Federation

111 1st Uspenskoe Shosse, Lapino, Moscow region 143081

143081 Московская обл., д. Лапино, 1-е Успенское шоссе, 111

https://orcid.org/0000-0003-4108-9956GlukhovE. V.ГлуховЕ. В.
Russian Federation

111 1st Uspenskoe Shosse, Lapino, Moscow region 143081

143081 Московская обл., д. Лапино, 1-е Успенское шоссе, 111

Clinical Hospital “Lapino” of the “Mother and Child” Group of companiesКлинический госпиталь «Лапино» группы компаний «Мать и дитя»160320233138471503202315032023Copyright ©; 2023, ABV-PressCopyright ©; 2023, АБВ-пресс2023ABV-PressАБВ-прессhttps://mdonco.abvpress.ru/jour/about/editorialPolicieshttps://mdonco.abvpress.ru/jour/article/view/62

Severe chronic pain syndrome with high requirement for opioids is frequently complicated by opioid tolerance, hyperalgesia, and other side effects. Special complications occur during anesthesia for high-injury surgical interventions and in the postoperative period. Perioperative pain management in these patients requires planning, multimodal approach, combination methods, and prevention of complications including specific complications. This article describes a case of successful surgical treatment of pancreatic cancer in a patient with severe chronic pain syndrome, opioid tolerance, and hyperalgesia. Perioperative period was complicated by high requirement for epidural pain management and use of adjuvants, acute strangulating intestinal obstruction on day 6 of the postoperative period. The authors had to differentiate between pain syndrome and abstinence multiple times and encountered the problem of tachyphylaxis to local anesthetics. Due to thought-out and flexible system of combination multimodal pain management, pain syndrome was relieved, and the patient was discharged in satisfactory condition without the need for opioids.

Тяжелый хронический болевой синдром с высокой потребностью в опиоидах часто осложняется опиоидной толерантностью, гипералгезией и другими побочными эффектами. Особые трудности возникают при проведении анестезии при высокотравматичных хирургических вмешательствах и в послеоперационном периоде. Периоперационная терапия боли у данной категории пациентов требует планирования, мультимодального подхода, сочетанных методик и профилактики осложнений, в том числе специфических.

Данная статья описывает случай успешного хирургического лечения рака поджелудочной железы у пациента с тяжелым хроническим болевым синдромом, опиоидной толерантностью и гипералгезией. Периоперационный период осложнился высокой потребностью в эпидуральном обезболивании и применении адъювантов, острой странгуляционной кишечной непроходимостью на 6-е сутки послеоперационного периода. Авторам пришлось многократно дифференцировать болевой синдром с абстиненцией, столкнуться с проблемой тахифилаксии к местным анестетикам. Благодаря продуманной и гибкой системе сочетанного мультимодального обезболивания удалось купировать болевой синдром и выписать пациента в удовлетворительном состоянии без потребности в опиоидах.

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