rmtОбщая реаниматологияGeneral Reanimatology1813-97792411-7110FSBI "SRIGR" RAMS10.15360/1813-9779-2011-5-46rmt-268Research ArticleОБЗОРЫ И КРАТКИЕ СООБЩЕНИЯREVIEWS & SHORT COMMUNICATIONSПроблема обезболивания в торакальной хирургии и пути решенияThe Problem of Analgesia in Thoracic Surgery and Ways of Its SolutionТимербаевВ. Х.TimerbayevV. Kh.-ГеновП. Г.GenovP. G.genov78@yandex.ruЛесникВ. Ю.LesnikV. Yu.-20112010201175Том VII № 5 2011 г.4646Copyright © Тимербаев В.Х., Генов П.Г., Лесник В.Ю., 20112011Тимербаев В.Х., Генов П.Г., Лесник В.Ю.Timerbayev V.K., Genov P.G., Lesnik V.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.reanimatology.com/rmt/article/view/268

Болевой синдром после торакальных операций является серьезной проблемой, на сегодняшний день далекой от разрешения. В раннем послеоперационном периоде пациенты, перенесшие торакотомию или торакоскопию, испытывают очень сильную боль, существенно превышающую по своей интенсивности боль после операций на органах брюшной полости, конечностях, головном мозге. По-прежнему остается актуальной проблема формирования послеоперационной хронической боли, когда пациенты торакальных хирургических отделений продолжают испытывать боль и нарушение чувствительности в грудной клетке, спустя месяцы и даже годы, после перенесенной операции. Кроме этической стороны вопроса, связанной с правом больного на адекватное обезболивание, существует опасность нарушения легочной функции у пациентов с неадекватно подобранной схемой анальгезии, что способствует развитию легочных и сердечных осложнений. В настоящее время в числе предложенных методов обезболивания фигурируют грудная эпидуральная анальгезия, многосегментарная па-равертебральная и межреберная блокады, субплевральная блокада, применение инфильтрационной анестезии в комплексе с общим обезболиванием, орошение современными местными анестетиками операционной раны и некоторые другие методы. В данном обзоре мы попытались суммировать накопленные на сегодняшний день знания в области обезболивания пациентов в торакальной хирургии, а также обозначить некоторые новые и перспективные направления лечения боли. Ключевые слова: торакальная хирургия, боль, обезболивание, послеоперационное обезболивание, гиперальгезия.

Pain syndrome after thoracic surgery is a serious problem that is far from being solved today. In the early postoperative period, the patients who have undergone thoracotomy or thoracoscopy have very severe pain that is more intense than that after operations on the abdomen, limbs, and brain. The development of postoperative chronic pain remains an urgent problem as before when the patients of thoracic surgical units continue to experience chest pain and insensitivity months and even years after surgery. In addition to the ethical aspect of the problem associated with a patient’s right to adequate analgesia, there is a risk for pulmonary dysfunction in patients for whom the analgesia mode has been inadequately chosen, which favors the development of pulmonary and cardiac complications. As of now, the proposed analgesia procedures include thoracic epidural analgesia, multi-segmental paravertebral and intercostal block, subpleural block, the use of infiltration anesthesia in combination with general anesthesia, surgical wound irrigation with local anesthetics, and some other methods. In this review, the authors have attempted to summarize today’s gained knowledge of anesthesia for thoracic surgery and to denote some new and promising areas in the treatment of pain. Key words: thoracic surgery, pain, analgesia, postoperative analgesia, hyperanalgesia.

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The authors declare that there are no conflicts of interest present.