Multimodal Analgesia for Battlefield Injury
Providing medical care in battlefield conditions also stipulates effective analgesia of the wounded person. The pain caused by the battlefield injury is inflammatory and neuropathic by pathophysiology. Hyperalgesia after injury may be a result of the nervous system sensitization caused by the injury and surgical nociception (hyperalgesia induced by nociception) or an effect of anesthetics and analgesics used for the treatment (hyperalgesia induced by drugs). Analgesics and anesthetics, which act as antagonists of different levels of the cascade dynorphin-k-receptor-glutamate/NMDA-receptor and COX-system or enhance the descending antinociceptive inhibitory pathways, have antihyperalgesic properties. This group of drugs includes ketamine, buprenorphine, nonsteroidal anti-inflammatory drugs, selective COX-2 inhibitors, paracetamol, a2-adrenoagonists (clonidine), nefopam, antidepressants, calcium channel a2b antagonists (gabapentin, pregabalin). The modern conception in the treatment of pain is multimodal analgesia. Multimodal analgesia - the use of several drugs or techniques which selectively affect the different physiological processes involved in nociception. The combination of antinociceptive and antihyperalgesic drugs can provide the additive or synergistic effects in the treatment of pain. The neuroaxial blockade with local anesthetic combined with buprenorphine, clonidine, nonsteroidal anti-inflammatory drugs, paracetamol, calcium channel a2b antagonists according to schedule is preferred among the methods of multimodal analgesia.