Postoperative analgesia in the surgical treatment of non-traumatic subarachnoid hemorrhage

A.Zh. Bayalieva1,2, R.Ja. Shpaner1,2, I.R. Ganeeva1,2

1 Kazan State Medical University, Kazan, Russian Federation

2 Interregional Clinical Diagnostic Center, Kazan, Russian Federation

For correspondence: Bayalieva Aynagul Zholdoshevna, Head of the Department of Anesthesiology and Reanimatology, disaster medicine of KSMU; e-mail: bayalieva1@yandex.ru

For citation: Bayalieva AZh, Shpaner RJa, Ganeeva IR. Postoperative Analgesia in the Surgical Treatment of Non-Traumatic Subarachnoid Hemorrhage. Alexander Saltanov Intensive Care Herald. 2018;1:37–42.

DOI: 10.21320/1818-474X-2018-1-37-42


The aim of the study was evaluation of headache treatment effectiveness in patients with non-traumatic subarachnoid hemorrhage, after surgical clipping of the aneurysm. The study included 105 patients, depending on the multimodal pain control method used, the following groups were formed: I — dexketoprofen or paracetamol; II — gabapentin plus dexketoprofen or paracetamol; III — Transdermal therapeutic system, the active element of which is fentanyl plus dexketoprofen or paracetamol. The drug of the reserve in all three groups was tramadol. The adequacy of the methods was judged by analgesic ability, using the Visual-Analog scale, and by the degree of influence on the level of consciousness, using of the Richmond Agitation-Sedation Scale. When evaluating the effectiveness of the methods, it was found that the combination of gabapentin and dexketoprofen/paracetamol is the most acceptable for this category of patients.

Keywords: postoperative pain, non-traumatic subarachnoid hemorrhage, multimodal analgesia

Received: 27.11.2017


References

  1. Rabinstein A.A., Lanzino G., Wijdicks E.F. Multidisciplinary management and emerging therapeutic strategies in aneurysmal subarachnoid haemorrhage. Lancet Neurol. 2010; 9(5): 504–519. doi: 10.1016/S1474–4422(10)70087–9.
  2. Баялиева А.Ж., Шпанер Р.Я., Ганеева И.Р., Насунов С.Ю. В поисках оптимального лечения головной боли при нетравматическом субарахноидальном кровоизлиянии. Анестезиология иреаниматология. 2017; 2: 149–152. [Bayalieva A.Zh., Shpaner R.Ja., Ganeeva I.R., Nasunov S.Ju. Searching the Optimal Treatment of Headache in Non-traumatic Subarachnoid Hemorrhage. Anaesthesiology and Reanimatology. 2017; 2: 149–152. (In Russ)]
  3. БаялиеваА.Ж., Шпанер Р.Я., Ганеева И.Р. Опыт лечения головной боли при остром нетравматическом субарахноидальном кровоизлиянии и оценка эффективности терапии. Казанский медицинский журнал. 2016; 6: 841–845. [Bayalieva A.Zh., Shpaner R.Ja., Ganeeva I.R. Practice in the treatment of headache in acute Non-traumatic Subarachnoid Hemorrhage and evaluation of the effectiveness of therapy. Kazan medical journal. 2016; 6: 841–845. (In Russ)]
  4. Mahon P., Smith B., Browne J., et al. Effective headache management in the aneurysmal subarachnoid patient: a literature review. British Journal of Neuroscience Nursing. 2012; 8(2): 89–93.
  5. Ганеева И.Р. Лечение головной боли у пациентов с нетравматическим субарахноидальным кровоизлиянием в интенсивной терапии. Регионарная анестезия илечение острой боли. 2017; 3: 164–169. [Ganeeva I.R. Management of headache in patients with non-traumatic subarachnoid hemorrhage. Regional anesthesia and treatment of acute pain. 2017; 3: 164–165. (In Russ)]
  6. Harrison R.A., Field T.S. Post stroke pain: identification, assessment, and therapy. Cerebrovasc. Dis. 2015; 39: 190–201. doi: 10.1159/000375397.
  7. Naess H., Lunde L., Brogger J. The effects of fatigue, pain, and depression on quality of life in ischemic stroke patients: the bergen stroke study. Vasc. Health Risk. Manag. 2012; 8: 407–413. doi: 10.2147/VHRM.S32780.
  8. O’Donnell M.J., Diener H.C., Sacco R.L., et al. Chronic pain syndromes after ischemic stroke: PRoFESS trial. Stroke. 2013; 44: 1238–1243. doi: 10.1161/STROKEAHA.111.671008.
  9. Hoang C.L., Salle J.Y., Mandigout S., et al. Physical factors associated with fatigue after stroke: an exploratory study. Top. Stroke Rehabil. 2012; 19: 369–376. doi: 10.1310/tsr1905–369.
  10. Lundström E., Smits A., Terént A., Borg J. Risk factors for stroke-related pain 1 year after first-ever stroke. Eur. J. Neurol. 2009; 16: 188–193. doi: 10.1111/j.1468-1331.2008.02378.x.
  11. Tang W.K., Liang H., Mok V., et al. Is pain associated with suicidality in stroke? Arch.Phys. Med. Rehabil. 2013; 94: 863–866. doi: 10.1016/j.apmr.2012.11.044.
  12. Овечкин А.М., Политов М.Е. Послеоперационное обезболивание с точки зрения доказательной медицины. Вестн. инт. терапии. 2016; 2: 51–60. [Ovechkin A.M., Politov M.E. Postoperative analgesia from evidence based medicine. Vestnik Intensivnoi Terapii. 2016; 2: 51–60. (In Russ)]
  13. Dorhout Mees S.M. MASH-II study group. Magnesium in aneurysmal subarachnoid hemorrhage (MASH II) phase III clinical trial. International Journal of Stroke. 2008; 3(1): 63–65. doi: 10.1111/j.1747-4949.2008.00168.x.
  14. Dorhout Mees S.M., Bertens D., van der Worp H.B.et al. Magnesium and headache after aneurysmal subarachnoid haemorrhage. J. Neurol. Neurosurg. Psychiatry. 2010; 81: 490–493. doi:10.1136/jnnp.2009.181404.
  15. Glisic E.K. Inadequacy of headache management after subarachnoid hemorrhage. American Journal of Critical Care. 2016; 25(2): 136–143. doi:10.4037/ajcc2016486.