Предупреждающая и мультимодальная анальгезия в стоматологии. Что может анестезиолог

Вопрос послеоперационного обезболивания в амбулаторной хирургии, в частности в стоматологии, остается актуальным как в России, так и за рубежом. В рамках данной работы выполнен анализ литературы на тему современных подходов к выбору метода обезболивания после амбулаторных стоматологических вмешательств, произведен обзор наиболее распространенных обезболивающих препаратов и их комбинаций. Рассмотрено влияние разных групп препаратов на механизмы формирования боли: трансдукцию, трансмиссию, модуляцию и перцепцию. В статье также отражены механизмы и особенности формирования боли в орофациальной области при стоматологической патологии. Проведенный анализ литературы показал, что на сегодняшний день в амбулаторной практике нет единого стандарта обезболивания пациентов во время и после стоматологических операций. Большое влияние на это оказывают национальные особенности разных стран, такие как наличие или запрет на ряд препаратов, а также доступность сильнодействующих и наркотических средств для назначения в амбулаторных условиях. На данный момент собранные в мировой специализированной литературе доказательства подтверждают эффективность использования принципов предупреждающей и мультимодальной анальгезии в стоматологической амбулаторной практике. Между тем, качественные сравнительные клинические работы, позволяющие подобрать наиболее эффективный и безопасный метод послеоперационного обезболивания, ограничены.

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