Проблема послеоперационного обезболивания, несмотря на постоянно проводимый поиск оптимальных методов и технологий, остается далека от своего разрешения. Спектр анальгетических средств, имеющихся в арсенале анестезиологов и врачей других хирургических специальностей, не всегда используется эффективно и целесообразно. Традиционное применение опиатных анальгетиков в послеоперационном периоде нередко осложняет его течение и ухудшает результаты хирургического лечения. Нестероидные противовоспалительные препараты, обладая как анальгетической, так и противовоспалительной активностью, могут быть успешно включены в мультимодальные схемы послеоперационного обезболивания и рассматриваться как компонент интенсивной терапии. В статье приведен обзор литературных источников, посвященных применению декскетопрофена – S(+)-кетопрофен – в периоперационном периоде, рассмотрены схемы его использования в качестве компонента мультимодального обезболивания.
The problem of postoperative pain relief, despite the constant conductivity of research for best practices and technologies, remains far from being solved. The spectrum of analgesics available in the arsenal of anesthesiologists and other surgical specialties is not always efficiently and expediently used. Traditional use of opioid analgesics in the postoperative period is often difficult and worsens the results of surgical treatment. Nonsteroidal anti-inflammatory drugs, possessing both analgesic and anti-inflammatory features, can be successfully incorporated into the multimodal scheme of postoperative analgesia and used as a component of intensive therapy. The article provides an overview of the literature on dexketoprophenum use – S(+)- ketoprophenum – perioperative, examining the scheme of its use as a component of multimodal analgesia.
1. Api O, Ergen B, Api M et al. Comparison of oral nonsteroidal analgesic and intrauterine local anesthetic for pain relief in uterine fractional curettage: a randomized, double-blind, placebo-controlled trial. Am J Obstet Gynecol 2010; 203 (1): 28.e1–7.
2. Barbanoj M, Rosa R, Arbos A, Rico Amaro S. Dexketoprofentrometamol: clinical evidence supporting its role as painkiller. Expert Rev Neurother 2008; 8: 1625–40.
3. Barden J, Derry S, McQuay HJ, Moore RA. Single dose oral ketoprofen and dexketoprofen for acute postoperative pain in adults. Cochrane Database Syst Rev 2009; 7 (4): CD007355.
4. Benhamou D, Berti M, Brodner G. Postoperative analgesic therapy observational survey (PATHOS): a practice pattern study in 7 Central/Southern European countries. Pain 2008; 136: 134–41.
5. Biki B, Mascha E, Moriarty D. Anesthetic technique for radical prostatectomy surgery affects cancer recurrence: a retrospective analysis. Anesthesiology 2008; 109: 180–7.
6. Chao C, Hu S, Molitor T. Morphine potentiates transforming growth factor-beta release from human peripheral blood mononuclear cell cultures. J Pharmacol Exp Ther 1992; 262; 19–24.
7. Coley K, Williams B, DaPos S. Retrospective evaluation of unanticipated admissions and readmissions after same day surgery and associated costs. J Clin Anest 2002; 14: 349–53.
8. Debre B. A double-blind (observer blind), randomised trial comparing the analgesic efficacy and safety of dexketoprofentrometamol (50 mg) with ketoprofen (100 mg) given as an intravenous infusion, in patients with renal or uretal colic. Clin Trial Report 2000.
9. Green GA. Understanding NSAIDs: from aspirin to COX-2. Clin Cornerstone 20013; 5: 50–60.
10. Harrison F. Double-blind randomised, parallel-group comparison of the safety and efficacy of oral dexketoprofen 25 mg with tramadol 50 mg in subjects with moderate to severe pain following orthopaedic surgery. Clin Trial Report 2001.
11. Jackson ID, Heidemann BH, Wilson J et al. Doubleblind, randomized, placebo-controlled trial comparing rofecoxib with dexketoprofentrometamol in surgical dentistry. Br J Anaesth 2004; 92: 675–80.
12. Jamali F, Brocks DR. Clinical pharmacokinetics of ketoprofen and its enantiomers. Clin Pharmacokinet 1990a; 19 (3): 197–217.
13. Laulin J-P, Maurette P, Rivat C. The role of ketamine in preventing fentanyl-unducedhyperalgesia and subsequent acute morphine tolerance. Anesth Analg 2002; 94: 1263–9.
14. Leman P, Kapadia Y, Herington J. Randomised controlled trial of the onset of analgesic efficacy of dexketoprofen and diclofenac in lower limb injury. Emerg Med J 2003; 20: 511–3.
15. Larcher A, Laulin J-P, Celerier E. Acute tolerance associated with a single opiate administration: involvement of N-methyl-D-aspartate-dependent pain facilitatory systems. Neuroscience 1998; 84: 583–9.
16. Osiri M, Moreland LW. Specific cyclooxygenase 2 inhibitors: a new choice of nonsteroidal anti-inflammatory drug therapy. Arthritis Care Res 1999; 12 (5): 351–62.
17. Marenco JL, Perez M, Navarro FJ et al. A multicentre, randomised, double-blind study to compare the efficacy and tolerability of dexketoprofen trometamol versus diclofenac in the symptomatic treatment of knee osteoarthritis. Clin Drug Invest 2000; 19: 247–56.
18. McCormack K, Urquhart E. Correlation 11 between nonsteroidal anti-infammator y drug effcacy in a clinical pain model and the dissociation of their anti-infammatory and analgesic proper ties in animals models. Clin Drug Investig 1995; 9: 88–97.
19. Merskey H, Bugduk N. Classification of Chronic Pain. Descriptions of Chronic Pain Syndromes and Definitions of Pain Terms. Seattle: WA, IASP Press, 1994.
20. Moore RA, Barden J. Systematic review of dexketoprofen in acute and chronic pain BMC. Clin Pharmacol 2008.
21. Peat S, Paredes I et al. Dexketoprofen trometamol versus tramadol in the relief of pain following ajororthopaedic surgery. 10th World Congress on Pain, IASP, San Diego, California, 2002.
22. Polomano R, Dunwoody C, Krenzischer D. Perspective on pain management in the 21st century. Pain Management Nurs 2008; 9: 3–10.
23. Sanchez-Carpena J, Sesma-Sanchez J, Sanchez-Juan C et al. Comparison of dexketoprofen trometamol and dipyrone in the treatment of renal colic. Clin Drug Invest 2003b; 23: 139–52.
24. Sanchez-Carpena J, Dominguez-Hervella F et al. Intravenous dexketoprofen compared to metamizole followed by oral treatment in acute renal colic. Annual Scientific Meeting, Glasgow 2003. The Pain Society (The British Chapter of ISAP) 2003a.
25. Schreiber M. Double-blind, randomised, parallel-group comparison of the safety and efficacy of single oral doses of dexketoprofen tromethamine salt (LM-1158.tris, 12,5 mg or 25 mg) with racemic ketorpofen (50 mg) and placebo in patients with moderate to severe pain following orthopaedic surgery. Clin Trial Report 1996.
26. Steinmeyer J. Pharmacological basis for the therapy of pain and inflammation with nonsteroidal anti-inflammatory drugs. Arthritis Res 2000;
2 (5): 379–85.
27. Tokgoz H, Yurtlu S, Hanci V et al. Comparison of the analgesic effects of dexketoprofen and diclofenac during shockwave lithotripsy: a randomized, double-blind clinical trial. J Endourol 2010; 24 (6): 1031-5. doi: 10.1089/end.2009.0257
28. Tuncer S, Tavlan A, Kostekci H et al. Postoperatifağrida deksketoprofen kullanimi. Agri 2006; 18: 30–5.
29. Vane JR. Inhibition of prostaglandin synthesis as a mechanism of action for aspirin-like drugs. Nat New Biol 1971; 231 (25): 232–5.
30. Vallés J, Artigas R et al. Single and repeated dose pharmacokinetics of dexketoprofen trometamol in patients with impaired liver function. Methods Find Exp Clin Pharmacol 2006a; 28 (Suppl. A): 29–36.
31. Vallés J, Artigas R et al. Single and repeated dose pharmacokinetics of dexketoprofen trometamol in young and elderly subjects. Methods Find Exp Clin Pharmacol 2006b; 28 (Suppl. A): 13–9.
32. Vallés J, Artigas R et al. Clinical pharmacokinetics of parenteral dexketoprofen trometamol in healthy subjects. Methods Find Exp Clin Pharmacol 2006c; 28 (Suppl. A): 7–12.
33. Vallés J, Artigas R et al. Pharmacokinetics of dexketoprofen trometamol in subjects with mild and moderate chronic renal insufficiency. Methods Find Exp Clin Pharmacol 2006d; 28 (Suppl. A): 21–8.
34. Vidal F, Martinez P, Montero A et al. Clinical trial to assess the analgesic efficacy and safety of LM-1158.TRIS (12.5 and 25 mg tid) versus ketoprofen (50 mg tid) and placebo after oral administration in patients with acute post-surgery pain. Clin Trial Report 1999.
35. Zippel H, Wagenitz A. Comparison of the efficacy and safety of intravenously administered dexketoprofen trometamol and ketoprofen in the management of pain after orthopaedic surgery: a multicentre, double-blind, randomised, parallel-group clinical trial. Clin Drug Investig 2006; 26 (9): 517–28.
36. Zeilhofer HU, Brune K. Analgesic strategies beyond the inhibition of cyclooxygenases. Trends Pharmacol Sci 2006; 27 (9): 467–74.
37. Simmons DL, Botting RM, Hla T. Cyclooxygenaseisozymes: the biology of prostaglandin synthesis and inhibition. Pharmacol Rev 2004; 56: 387–437.
________________________________________________
1. Api O, Ergen B, Api M et al. Comparison of oral nonsteroidal analgesic and intrauterine local anesthetic for pain relief in uterine fractional curettage: a randomized, double-blind, placebo-controlled trial. Am J Obstet Gynecol 2010; 203 (1): 28.e1–7.
2. Barbanoj M, Rosa R, Arbos A, Rico Amaro S. Dexketoprofentrometamol: clinical evidence supporting its role as painkiller. Expert Rev Neurother 2008; 8: 1625–40.
3. Barden J, Derry S, McQuay HJ, Moore RA. Single dose oral ketoprofen and dexketoprofen for acute postoperative pain in adults. Cochrane Database Syst Rev 2009; 7 (4): CD007355.
4. Benhamou D, Berti M, Brodner G. Postoperative analgesic therapy observational survey (PATHOS): a practice pattern study in 7 Central/Southern European countries. Pain 2008; 136: 134–41.
5. Biki B, Mascha E, Moriarty D. Anesthetic technique for radical prostatectomy surgery affects cancer recurrence: a retrospective analysis. Anesthesiology 2008; 109: 180–7.
6. Chao C, Hu S, Molitor T. Morphine potentiates transforming growth factor-beta release from human peripheral blood mononuclear cell cultures. J Pharmacol Exp Ther 1992; 262; 19–24.
7. Coley K, Williams B, DaPos S. Retrospective evaluation of unanticipated admissions and readmissions after same day surgery and associated costs. J Clin Anest 2002; 14: 349–53.
8. Debre B. A double-blind (observer blind), randomised trial comparing the analgesic efficacy and safety of dexketoprofentrometamol (50 mg) with ketoprofen (100 mg) given as an intravenous infusion, in patients with renal or uretal colic. Clin Trial Report 2000.
9. Green GA. Understanding NSAIDs: from aspirin to COX-2. Clin Cornerstone 20013; 5: 50–60.
10. Harrison F. Double-blind randomised, parallel-group comparison of the safety and efficacy of oral dexketoprofen 25 mg with tramadol 50 mg in subjects with moderate to severe pain following orthopaedic surgery. Clin Trial Report 2001.
11. Jackson ID, Heidemann BH, Wilson J et al. Doubleblind, randomized, placebo-controlled trial comparing rofecoxib with dexketoprofentrometamol in surgical dentistry. Br J Anaesth 2004; 92: 675–80.
12. Jamali F, Brocks DR. Clinical pharmacokinetics of ketoprofen and its enantiomers. Clin Pharmacokinet 1990a; 19 (3): 197–217.
13. Laulin J-P, Maurette P, Rivat C. The role of ketamine in preventing fentanyl-unducedhyperalgesia and subsequent acute morphine tolerance. Anesth Analg 2002; 94: 1263–9.
14. Leman P, Kapadia Y, Herington J. Randomised controlled trial of the onset of analgesic efficacy of dexketoprofen and diclofenac in lower limb injury. Emerg Med J 2003; 20: 511–3.
15. Larcher A, Laulin J-P, Celerier E. Acute tolerance associated with a single opiate administration: involvement of N-methyl-D-aspartate-dependent pain facilitatory systems. Neuroscience 1998; 84: 583–9.
16. Osiri M, Moreland LW. Specific cyclooxygenase 2 inhibitors: a new choice of nonsteroidal anti-inflammatory drug therapy. Arthritis Care Res 1999; 12 (5): 351–62.
17. Marenco JL, Perez M, Navarro FJ et al. A multicentre, randomised, double-blind study to compare the efficacy and tolerability of dexketoprofen trometamol versus diclofenac in the symptomatic treatment of knee osteoarthritis. Clin Drug Invest 2000; 19: 247–56.
18. McCormack K, Urquhart E. Correlation 11 between nonsteroidal anti-infammator y drug effcacy in a clinical pain model and the dissociation of their anti-infammatory and analgesic proper ties in animals models. Clin Drug Investig 1995; 9: 88–97.
19. Merskey H, Bugduk N. Classification of Chronic Pain. Descriptions of Chronic Pain Syndromes and Definitions of Pain Terms. Seattle: WA, IASP Press, 1994.
20. Moore RA, Barden J. Systematic review of dexketoprofen in acute and chronic pain BMC. Clin Pharmacol 2008.
21. Peat S, Paredes I et al. Dexketoprofen trometamol versus tramadol in the relief of pain following ajororthopaedic surgery. 10th World Congress on Pain, IASP, San Diego, California, 2002.
22. Polomano R, Dunwoody C, Krenzischer D. Perspective on pain management in the 21st century. Pain Management Nurs 2008; 9: 3–10.
23. Sanchez-Carpena J, Sesma-Sanchez J, Sanchez-Juan C et al. Comparison of dexketoprofen trometamol and dipyrone in the treatment of renal colic. Clin Drug Invest 2003b; 23: 139–52.
24. Sanchez-Carpena J, Dominguez-Hervella F et al. Intravenous dexketoprofen compared to metamizole followed by oral treatment in acute renal colic. Annual Scientific Meeting, Glasgow 2003. The Pain Society (The British Chapter of ISAP) 2003a.
25. Schreiber M. Double-blind, randomised, parallel-group comparison of the safety and efficacy of single oral doses of dexketoprofen tromethamine salt (LM-1158.tris, 12,5 mg or 25 mg) with racemic ketorpofen (50 mg) and placebo in patients with moderate to severe pain following orthopaedic surgery. Clin Trial Report 1996.
26. Steinmeyer J. Pharmacological basis for the therapy of pain and inflammation with nonsteroidal anti-inflammatory drugs. Arthritis Res 2000;
2 (5): 379–85.
27. Tokgoz H, Yurtlu S, Hanci V et al. Comparison of the analgesic effects of dexketoprofen and diclofenac during shockwave lithotripsy: a randomized, double-blind clinical trial. J Endourol 2010; 24 (6): 1031-5. doi: 10.1089/end.2009.0257
28. Tuncer S, Tavlan A, Kostekci H et al. Postoperatifağrida deksketoprofen kullanimi. Agri 2006; 18: 30–5.
29. Vane JR. Inhibition of prostaglandin synthesis as a mechanism of action for aspirin-like drugs. Nat New Biol 1971; 231 (25): 232–5.
30. Vallés J, Artigas R et al. Single and repeated dose pharmacokinetics of dexketoprofen trometamol in patients with impaired liver function. Methods Find Exp Clin Pharmacol 2006a; 28 (Suppl. A): 29–36.
31. Vallés J, Artigas R et al. Single and repeated dose pharmacokinetics of dexketoprofen trometamol in young and elderly subjects. Methods Find Exp Clin Pharmacol 2006b; 28 (Suppl. A): 13–9.
32. Vallés J, Artigas R et al. Clinical pharmacokinetics of parenteral dexketoprofen trometamol in healthy subjects. Methods Find Exp Clin Pharmacol 2006c; 28 (Suppl. A): 7–12.
33. Vallés J, Artigas R et al. Pharmacokinetics of dexketoprofen trometamol in subjects with mild and moderate chronic renal insufficiency. Methods Find Exp Clin Pharmacol 2006d; 28 (Suppl. A): 21–8.
34. Vidal F, Martinez P, Montero A et al. Clinical trial to assess the analgesic efficacy and safety of LM-1158.TRIS (12.5 and 25 mg tid) versus ketoprofen (50 mg tid) and placebo after oral administration in patients with acute post-surgery pain. Clin Trial Report 1999.
35. Zippel H, Wagenitz A. Comparison of the efficacy and safety of intravenously administered dexketoprofen trometamol and ketoprofen in the management of pain after orthopaedic surgery: a multicentre, double-blind, randomised, parallel-group clinical trial. Clin Drug Investig 2006; 26 (9): 517–28.
36. Zeilhofer HU, Brune K. Analgesic strategies beyond the inhibition of cyclooxygenases. Trends Pharmacol Sci 2006; 27 (9): 467–74.
37. Simmons DL, Botting RM, Hla T. Cyclooxygenaseisozymes: the biology of prostaglandin synthesis and inhibition. Pharmacol Rev 2004; 56: 387–437.
Авторы
С.В.Сокологорский
ГБОУ ВПО Первый Московский государственный медицинский университет им. И.М.Сеченова Минздрава России