[Antinociceptive components of general anesthesia and postoperative analgesia]

The philosophy of full-value antinociceptive protection of patients during and after surgical interventions is discussed. The author presents her viewpoint on the problem with due consideration for recent published reports. She advocates a prophylactic approach to attaining the antinociceptive protection (the so-called "preemptive analgesia"). Analgesics of peripheral action are the main means for protection at the peripheral level. Peripheral antialgogens contrycal (trasilol), acelysin (aspisol), baralgine, diclofenac, and ketorolac were effectively used during the pre-, intra-, and postoperative periods: the course of total anesthesia and postoperative period improved, intensity of the painful syndrome and the need in opioids was decreased, and wound healing improved. For preventing secondary (central) hyperalgesia and decreasing the intensity of postoperative painful syndrome, NMDA-receptor antagonist ketamine in microdoses is recommended before and during surgery. Afferent nociceptive flow can be decreased by local and regional anesthesia. Practical application of the preemptive analgesia principle improves the efficacy and safety of analgesia at different stages of surgical treatment, decreases total and local (at the level of operated tissues) consequences of surgical trauma, and decreases the probability of complications.