Периоперационное обезболивание у опиоидзависимого пациента с хронической болью: современные подходы и подводные камни. Описание клинического случая

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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