MONITORING OF PAIN IN HEMATOLOGICAL PATIENTS
Keywords:
pain, ANI, hematologyAbstract
Purpose: to evaluate the methods of pain monitoring during anesthesia and resuscitation in hematological patients. Materials and methods: In a prospective, descriptive single center study various methods of pain assessment were evaluated in hematological patients with impaired consciousness, after general anesthesia and after spinal anesthesia. Index of nociception and analgesia (ANI, MetroDoloris), vegetative index (VI), heart rate (HR), mean arterial blood pressure (MAP), modern scale pain scores (Numeric Rating Scale (NRS) and Nociception Coma Scale, (NCS)) were evaluated. Results: In comatose patients and patients after general anesthesia, the reactions to nociception stimulus were saved and revealed with ANI monitor. During bronchoscopy and gastroscopy, ANI decreased from baseline of 90 to 20-30, during pinprick for blood taking ANI decreased to 40, during central catheter insertion ANI decreased to 30. The ranges of the changes of HR, MAP and VI corresponded to ANI, but these changes were insignificant and not available to evaluate the pain in comatose patients. In patients after spinal anesthesia, ANI data, except that correspond to the restoration of sensory-motor block, were sensitive to pain. ANI decreased from 52 to 38 an hour before spinal block recourse. These data were used to start the postoperative analgesia. At the same time changes of HR, MAP and VI weren’t informative. Conclusions: Visualization and objectification pain seems possible only by means of a comprehensive assessment of various parameters: ANI, VI, hemodynamic parameters, modern pain assessment scales. The use of ANI is represented to the most informative; however these data demand further studying.
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