Pain reliever for pain after surgery. Painkillers for injections after surgery. Names and applications. Non-narcotic analgesics drugs

Use of analgesics various groups during the period postoperative rehabilitation caused by the elimination pain syndrome, improving the quality of life of the patient, reducing complications and length of stay in a medical institution.

Pain relief after surgery helps the body recover faster

What pain relievers are available after surgery? Types and features of drugs

In hospitals and clinics there is a formulary system for the use of medicines of various groups. Their application depends on the characteristics and needs in each case. The need to use must be confirmed medical research.

Painkillers after surgery. Pain relievers

Drugs intended for postoperative analgesia are presented in the table.

In turn, narcotic drugs are divided into:

• synthetic;
• semi-synthetic;
• based on natural ingredients.

The drugs in this group have a pronounced analgesic effect. It is this property that is most important in the postoperative state.

Pain injections after surgery, namely the use of opiates, are justified during the first 3 days after complex operations. Further use may adversely affect the human psyche. This is due to the fact that drugs cause a psychotropic effect for a while, as a result of which drug addiction may develop.

Side effects of these injections may include:

• vomit;
• nausea;
• increased intestinal tone;
• disturbances in the work of the heart.

The emergence of such unpleasant consequences can be avoided by correct dosage and short term use.

Attention! The use of opioid painkillers after surgery is allowed only in accordance with certain norms and in cases established by the relevant law of the Russian Federation in the field of healthcare.

Drugs that do not contain drugs, pain relief is weaker. Their advantage is the relief of heat and inflammation in the body. It is this ability that makes them indispensable when used after surgery.

Improper use of such drugs can lead to a deterioration in the patient's condition.

Pain most often appears and intensifies precisely because of inflammation of various etiologies.

The process of stopping the focus occurs due to the blocking of certain enzymes. They contribute to the appearance of the inflammatory process in the body.

Regarding the antipyretic ability, there is an assumption that the synthesis of prostaglandins, which causes an increase in temperature, is disturbed due to the influence active substance Ketonal - ketoprofen.

The drug belongs to the group of non-steroidal anti-inflammatory drugs, the use of which has its positive and negative sides.

1. Reduce tissue swelling.
2. Impact on the center of inflammation and its relief.
3. Reduced blood clotting by reducing platelet aggregation.
4. The ability to quickly reduce the intensity of pain for up to 8 hours. This property is especially valuable for the use of analgesic injections of Diclofenac after surgery.

diclofenac

The use of injections is justified not only in the postoperative period, but in the case of:

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The most powerful painkillers injections and drugs

If a person's pain intensifies, then strong painkillers are prescribed. Similar drugs can only be prescribed by a doctor.

Many have significant contraindications.

In modern medicine, all painkillers are divided into 2 groups:

• non-narcotic;
• narcotic.

The most common among narcotic painkillers are drugs: morphine, codeine, they are classified as opioid drugs.

Also widely used are:

• morphilong;
• omnopon;
• ethylmorphine;
• nabulfin;
• promedol;
• tramadol.

Anesthesia is carried out for the partial or complete disappearance of pain. Depending on the etiology of the disease and its symptoms, the severity of the disease, appropriate anesthesia is carried out, moreover, if painkillers in the form of tablets do not help, a person is given intramuscular or intravenous injections.

Application after surgery

After surgery, injections with a strong analgesic effect are most often administered in combination with other analgesics - paracetamol and narcotic analgesic.

Deserved attention in medical practice such drugs as:

1. An anesthetic injection Ketorol relieves exacerbation in postoperative period. Its main active ingredient is ketorolac, which helps to reduce severe pain. Contraindicated in people with drug intolerance, if there is an allergy to aspirin, ulcers, bronchial asthma, various postoperative bleeding, liver and kidney diseases. The drug should not be used for a long time.
2. Rofecoxib, or Denebol, is one of the most modern means, it is reliable and easy to use. Its properties are to suppress the synthesis of the inflammatory process. The drug has a long duration of action, is safe: it can be prescribed to patients with peptic ulcer.

Application in oncology

The strongest painkillers postoperative injections for oncology are divided into 3 groups:

• non-narcotic;
• narcotic;
• auxiliary.

Analgesics are prescribed depending on the stage of the disease and the degree of pain.

If the pain syndrome is very pronounced, opiates are used, with an average pain syndrome - non-narcotic content, with mild pain - auxiliary painkillers.

Potent drugs:

• diamorphine is used to anesthetize only incurable patients when it is necessary to alleviate the patient's condition;
• tramal is a narcotic analgesic that is rapidly absorbed into the blood, therefore, contributing to rapid pain relief.

Of course, the most powerful painkillers injections are drugs of the narcotic group, they are administered in the most severe forms of oncology and other diseases. They have special value, as they produce a strong analgesic effect in the postoperative period.

Hydromorphone, oxidone, morphine and other drugs are a kind of one group of substances that have general indications for use, differing in doses and time of use. They are considered the most powerful drugs.

These funds suggest complete relief from pain during the period of the active substance. Pain relief occurs almost immediately.

All drugs of the opiate group cause side effects, expressed depending on the drug (to a greater or lesser extent):

• insomnia;
• nausea;
• vomit;
• depression;
• muscle pain;
• convulsions;
• thoughts of suicide.

Opiate prescriptions are contraindicated if:

• individual hypersensitivity to the drug;
• in the case of conditions associated with respiratory depression or severe depression of the central nervous system;
• with severe liver and kidney failure;
• drug withdrawal syndrome.

In almost all cases where pain relief is needed, ranging from the simplest headache or abdominal pain to the most complex operations, modern medicine uses intramuscular and intravenous injections based on diclofenac, ketorolac or ketoprofen. Sometimes pills are prescribed.

Effective and proven pain relief injections in the joints

List of painkillers in the form of injections for joint pain:

1. Hydrocortisone is the best anti-inflammatory, anti-allergic agent; broad-spectrum drug. When administered, there is a caveat: an injection is injected into no more than 3 joints in one day, then a three-week break must be taken. The same joint can be treated only 3 times a year.
2. Prednisone is the most good analogue hydrocortisone, can reduce inflammation. It can not be used for a long time due to a decrease in the body's resistance to infections.

Use for back pain

Cases of the introduction of painkillers injections for back pain are as follows:

1. Inflammation of muscle tissue, hernia, backache, arthritis.
2. For pain in the lower back, neuroses of various etiologies, non-steroidal groups of drugs are used.
3. With lumbago, to restore the motor function of the body.

These drugs include:

1. Diclofenac is a fairly common pain reliever that can quickly, sometimes with a single injection, localize the pain syndrome, but it has strong side effects: this drug should be taken very carefully by people suffering from diseases of the stomach, liver, and kidneys. Since the medicine is strong, the course of treatment is usually 5 days. It is not recommended to take the drug for people with ulcers, chronic cholecystitis or gastritis, pregnant women and young children.
2. With hernias, betamethosone is administered, which contributes to the almost instantaneous elimination of the focus of inflammation. Betamethasone is not only an anti-inflammatory, but also an anti-allergic agent. You can not use the drug for tuberculosis of the skin, skin infections various etiologies.
3. Ketonal - the best anti-inflammatory drug, is not only an anesthetic, but also an antipyretic. The substance is based on ketaprofen, which does not adversely affect articular cartilage, as a result of which it is prescribed for back muscle injuries, rheumatoid and reactive arthritis, myalgia, osteoarthritis, sciatica. It is recommended to use with caution in the elderly.

Do not use Ketonal for:

• ulcer;
• pathologies of blood clotting;
• severe renal, hepatic and heart failure;
• various types of bleeding or suspected bleeding;
• not recommended for children and pregnant women and women during breastfeeding.

Useful video on the topic

What else you need to read:

Use for painful periods

With menstruation, accompanied by severe pain, sometimes nausea, analgesic injections of No-shpa are prescribed. The main active ingredient is drotaverine hydrochloride. There is a specially designed formula for injections during menstrual pain.

Contraindications:

• do not use the drug in case of hypersensitivity to the drug;
• with severe renal, hepatic or heart failure;
• for medical reasons.

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Pain relief medications after surgery

During the operation, tissues, muscles, bones are damaged, so the person feels pain. Pain medications after surgery help to relieve a person from pain, as a result of which the body recovers more efficiently. Pain is a signal that not all is well in the human body. It does not allow you to ignore the problem that has arisen. Each person relates to pain in their own way, has its own pain threshold. It is quite natural that every person who has undergone or is about to undergo surgery is interested in the question of what relieves pain after surgery.

Any operation is a huge stress for a person, and especially one whose pain threshold is low. The postoperative period is necessarily accompanied by significant pain, you need to understand this, but you don’t need to endure them. Therefore, after surgical intervention, the appointment of powerful analgesics, which will help improve a person's well-being and make the recovery period shorter and more efficient. Painkillers, which are available in every home, are unlikely to help here. Pain injections are usually used immediately after the operation, and in the future, the doctor may prescribe pills.

Pain relief methods

After surgery, it is possible to use several types of analgesics:

The easiest and most convenient is the oral route. When an epidural catheter is used, a person may experience pain, discomfort may occur, and inflammation of nearby tissues sometimes develops, but there are times when this method is simply necessary.

The essence of this method is that an analgesic is injected with a puncture needle into the region of the spinal cord, and then a catheter is attached. Often the use of this method is accompanied by unpleasant sensations:

• nausea and vomiting;
• headache;
• drop in blood pressure;
• weakness in the legs.

The least common side effects are observed when an anesthetic gel or ointment is used.

Tablets help relieve pain in about half an hour, while painkillers after surgery have their effect within 2-3 minutes. Therefore, in order to relieve pain after surgery, doctors prescribe injections. Ointments and gels are more often used as an additional remedy.

The most modern method is autoanalgesia, but in order to use it, a medical institution must have the appropriate material and technical base. With this method, an infusion pump is used to deliver analgesics to the blood. It has a button with which the patient can independently regulate the amount of medication received.

What are analgesics

Modern analgesics are divided into 2 main groups - they can be narcotic and non-narcotic. Drugs are:

• based on natural substances;
• semi-synthetic;
• synthetic.

These funds have a number of distinctive features:

1. They have a strong analgesic effect, this property is especially valuable after surgery.
2. They are able to have some psychotropic effect, improve mood, bring a person into a state of euphoria, as a result of which drug addiction may develop. Therefore, these drugs are used for a limited time.
3. Serious side effects may develop. Sometimes, when using these drugs, nausea and vomiting occur, cardiac activity is disturbed, and intestinal tone increases.

But these drugs are highly effective as strong painkillers. If you choose the right dose and use them for a short time, the risk of side effects is minimal. Pharmacies dispense narcotic drugs only on special prescription doctor.

In non-narcotic drugs, the analgesic effect is much less pronounced, but they also have an anti-inflammatory and antipyretic effect, which is important immediately after surgery. But apart from undeniable benefit, these funds can cause harm if used improperly. Their side effects are a negative effect on the mucous membrane of the stomach and intestines, kidneys.

Characteristics of narcotic painkillers

One of the strongest narcotic analgesics is morphine. An injection of this drug almost completely relieves a person of any pain. Morphine relieves pain in a few minutes and works for 5 hours.

Morphine is a powerful analgesic that other drugs cannot compete with. Therefore, lighter drugs are usually prescribed immediately after the operation, and Morphine is used only if they are not effective enough. There are serious contraindications for its use:

• severe respiratory and hepatic pathologies;
• epilepsy;
• severe alcohol intoxication.

Morphine is available in the form of injections and tablets, the effectiveness of which is almost the same.

Morphine, among other components, is part of a drug such as Omnopon. This remedy has the same strong analgesic effect as Morphine. Its difference is in fewer side effects. It is available only in the form of injections.

Promedol is a synthetic analogue of Morphine. The analgesic effect is somewhat less pronounced, the duration of exposure is shorter than that of Morphine. It has almost the same side effects, with one exception - less depression of the respiratory center. Therefore, Promedol is used in cases where the use of Morphine is not possible, for example, when the patient has severe respiratory failure. Promedol is available in tablets and ampoules for injection.

Another synthetic opiate is Tramadol. It has a strong analgesic effect, differs in the duration of action - about 8 hours. Available in tablets and in solution for injection, they have almost the same effect. A distinctive feature of Tramadol: its use almost does not develop side effects. It is contraindicated only with severe alcohol intoxication and its use is prohibited for pregnant women.

Characteristics of non-narcotic analgesics

These drugs relieve pain much weaker than narcotic counterparts. Therefore, they are not used for the first time after the operation. First, opioid injections are prescribed, and then, after some time, drugs are used in tablets.

Painkillers after surgery Diclofenac take effect in about 30 minutes. The drug has a good absorption capacity, due to which its analgesic effect can manifest itself in any organ. Therefore, it is widely used in various types of surgical interventions. The gold standard - so it is quite justifiably called this remedy among analogues.

Usually, injections of the drug are first prescribed, and the transition to the tablet form of the drug is gradually made.

Diclofenac has one serious drawback - wide range side effects. If it is used for a long time, the mucous membrane of the digestive tract is affected, a stomach or duodenal ulcer may occur.

lesser side effect has Nimesulide. This is a more modern tool, which is more secure. Analgesic properties are almost equal to Diclofenac, but Nimesulide has a longer duration of action. But the drug is not available in the form of injections, but only in tablets. Therefore, immediately after the operation, its use is unjustified. If you use the remedy for a long time, the risk of side effects increases.

The most modern, reliable, safe and convenient of painkillers is Rofecoxib. It is produced, in addition to tablets, also in ampoules. Therefore, it is often used in the first days after surgery. A huge plus of the drug is that it is practically safe. It does not affect digestive system, so even patients with peptic ulcer can take it without fear. It differs in the duration of exposure, well reduces pain.

Drugs available in every home

Means from this group can be purchased without a prescription at a pharmacy, and for sure everyone has them at home. Of course, their effectiveness immediately after surgery is rather controversial, since they have weak analgesic properties. But if some time has passed after the operation, the person has been discharged from the hospital, these analgesics can also be used to relieve residual mild postoperative pain.

These drugs include Ketanov. There are certain restrictions on its appointment. For example, it should not be taken by children under 16, pregnant and lactating women, people suffering from asthma, stomach ulcers and some other diseases. Otherwise, the drug is quite effective.

Analgin in modern medicine has a controversial reputation. He copes well with his main task, but at the same time, the hematopoietic system, kidneys, and liver are affected. Modern doctors believe that analgin should be used in extreme cases.

Aspirin and Paracetamol are weak analgesics. They have been used in medicine for a long time and have a number of contraindications. For example, aspirin has a negative effect on the mucous membrane of the digestive organs, and in children - on the liver.

However, any pain medication must be prescribed by the attending physician, especially in such serious situations as the condition after surgery. Currently, there are many modern means that can significantly improve the well-being of a person after surgery and help his body to fully recover.

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How is anesthesia administered after surgery?

Pain is defensive reaction organism. It signals a person about the problem and does not allow it to be ignored. After the operation, due to damage to tissues, muscles, bones, a pain impulse occurs, passing along the nerves to the brain. Taking analgesics makes it possible to block it, to carry out an effective recovery of the body after surgery, to save the patient from suffering.

Pain relief after surgery: goals and effectiveness

Postoperative pain relief is aimed at eliminating pain and creating good conditions for the recovery of the body. Each person has their own pain threshold and attitude towards pain. Poor analgesia causes severe discomfort, unpleasant emotions, interferes with sleep. To avoid this, drugs are prescribed even before the formation of a pain impulse, taking into account the degree of tissue damage, the patient's well-being. Anesthesia during pregnancy is carried out according to special schemes, taking into account the degree of benefit / risk for the mother and fetus.

Tip: for the correct measurement of pain, the so-called pain ruler is used (a ten-point scale of pain intensity). If you do not feel a significant effect from the analgesic, ask to have your score measured and make adjustments to the pain management regimen.

Methods of analgesia

Using an epidural catheter

After surgery, painkillers are prescribed orally (to be taken orally: tablets, syrups), topically in the form of ointments or injected into the blood, muscles with an injection, venous cannula, epidural catheter. The first method is the simplest, safest and most convenient. But last method often hurts discomfort, can provoke the development of inflammation at the injection site, but in some cases it can not be dispensed with. When using an epidural catheter (before the operation, the anesthesiologist injects an anesthetic with a puncture needle into the epidural space between the hard shell of the spinal cord and the periosteum of the vertebrae, and then connects the catheter) during or after the intervention, the patient may feel unpleasant symptoms:

• nausea, vomiting;
• weakness in the legs;
• violation of urination;
• lowering blood pressure;
• headache, back pain.

When using ointments, gels with analgesic effect, the probability side effects minimal.

Different types conduction anesthesia (plexus - affects nerve plexuses, stem, epidural, spinal, when there is a blockade of the nerve trunks and plexuses above the operation site) allow for high-quality anesthesia during operations on the organs of the abdominal cavity, pelvis, limbs.

The most popular types of analgesics

An obligatory component of analgesic therapy is drugs that support the microflora of the stomach and intestines.

Painkillers begin to act approximately half an hour after ingestion, rectal suppositories (introduced into the rectum) act faster. But injections give the expected result in a few minutes. Medications should be taken regularly certain time. In some cases, anesthetic ointments are additionally recommended for local application(for example, Katejel, Eplan).

Tip: if the material and technical base of the medical facility allows, the patient may be offered autoanalgesia (PCA) in combination with epidural, intravenous medication, when painkillers are delivered using an infusion pump with a button. With its help, the patient can control the dose himself (the device is programmed so that more than the allowable amount will not come).

Most doctors agree that several analgesic drugs after discharge from the hospital should be taken in a checkerboard pattern. Then the effect of one remedy will continue the effect of another without unnecessary harm to the body.

Tip: Ketanov (available in the form of tablets, injection solution) can cause severe stomach disorders, so you need to take it strictly on the recommendation of a doctor and not exceed optimal dose and term of admission (no more than 5 days).

High-quality analgesia, including local in the form of an ointment, gel, will facilitate the postoperative period for the patient and will make it possible to carry out effective rehabilitation of the body, and return to normal life faster.

Attention! The information on the site is presented by specialists, but is for informational purposes only and cannot be used for self-treatment. Be sure to consult a doctor!

What painkillers after surgery can be prescribed? This question worries many people, because no one is immune from surgery. The human body has long been subject to the negative influence of microorganisms: bacteria and viruses that destroy human health. Pests of the body live due to the fact that they infect human tissues and organs and, therefore, cause significant harm to human health.

In our time, medicine is developing so rapidly and rapidly that harmful microorganisms do not have time to adapt to various antibiotics, medicines and drugs. So, one of the most miraculous ways is an operation, during which one or another type of disease is eliminated. However, some people experience severe pain as they gradually recover from anesthesia. How, then, at least for a while, to extinguish severe pain, if it brings a person even to tears?

A variety of drugs today

Any medical substance (for example, painkillers, pills or antibiotics) can help to gain full health to the human body. The question, most likely, is not in the types existing drugs but in the correctness of their application. Thus, if any medical medicine there are many negative consequences.

According to numerous social observations, the most common way of suicide is drug overdose.

Medicine is developing rapidly, making new discoveries almost every day. To date, pain pills after surgery are not something new and unattainable.. So, if the patient experiences acute discomfort after the operation, a variety of medications come to the rescue.

If the operation relieves the human body of the disease, then why does the person experience acute malaise?

An operation is a medical effect on the human body, the purpose of which is to eliminate developing disease in the human body. Of course, the operation is carried out exclusively with the participation of doctors who have received a license in a particular field. However, the question arises: if the operation relieves the body of the disease, why does the person feel unwell after? The answer to this is the structural features human body. The fact is that human tissues are a collection of similar cells that perform the same functions. Almost every tissue of the human body is affected by third-party objects, which leads to its modifications. For example, when cut with a knife, tissue is destroyed, after which bleeding begins. A similar effect occurs during surgery: the tissues of the human body are amenable to surgical intervention, after which they experience the process of "rehabilitation".

To put it as simply as possible, the doctor destroyed the tissue (made an incision) and restored it (sewn up the wound). The human body feels pain after the action, as the tissue, restoring its structure, excites the nervous system. It is known that the nervous system is the "foundation" of the human body. When excited nerve endings The human body receives signals in the form of pain sensations.

Drugs, antibiotics and pills that can help a person with pain

The pain experienced after surgery is very often so severe that a person cannot even move, as this brings him catastrophic discomfort. However, modern medicine is able to offer a variety of painkillers, drugs and drugs that can extinguish any, even the most severe pain that has arisen in the human body.

The traditional approach in treating a patient after surgery is to "combine" a variety of drugs. Naturally, in order to avoid various injuries, you should not take them on your own. The attending physician should give you recommendations, after which you can proceed directly to the treatment itself. However, more often than not, doctors prefer to treat their patients on their own.

The "combination" method consists in the use of a variety of drugs, the purpose of which is the general repayment of pain after surgery. However, each medicine is unique in its own way and acts on the human body depending on the specified composition. By building a “scheme” for taking medications, the doctor starts the process of pain relief in your body.

To date, painkillers are one of the best friends of the human body. Unique in their structure and action, these drugs are able to save the human body from severe pain.

Types of painkillers after surgery

Paracetamol is one of the most popular pain relievers for the terrible pain after surgery.

Penetrating into the fire, paracetamol tablets activate the vital processes of the human body, which contributes to the speedy recovery of the affected area of ​​the body.

Painkillers are sold in almost every modern pharmacy and have a relatively low price.

Anesthesia of the body after surgery often takes place with the participation of Ketone tablets. This type of medicine is not used for chronic diseases and has a number of limitations. For example, the drug should not be taken: children under the age of 16, pregnant women, breastfeeding, asthma, diathesis, ulcers, and so on. So, under the influence of this drug, anesthesia occurs not only after surgery, but also, for example, with osteochondrosis, menstruation, fractures, tissue structure disorders, oncology, abdominal pain, and even after the removal of a diseased tooth.

It is important to have a drug such as aspirin. This drug helps to cope with pain in different parts of the human body, as well as high temperature. However, like all drugs, aspirin has a number of limitations. For example, the use of the drug is contraindicated in inflammation gastrointestinal tract, pain during menstruation and children, including adolescence. Thus, the use of aspirin can cause the development of liver disease in adolescents and even affect human brain. By the way, aspirin is quite cheap.

One of the controversial painkillers modern medicine is analgin, which affects the human body. For example, it is much more effective than paracetamol. However, this drug adversely affects the circulatory system, liver, kidneys and lymphatic system. Modern doctors are of the opinion that this device should be used only in case of critical need. For example, when other painkillers did not have the desired effect.

The main objectives of the use of analgesics in the postoperative period are: the elimination of suffering caused by pain, the creation of psychological comfort and improving the quality of life of patients in the postoperative period; acceleration of postoperative functional rehabilitation; frequency reduction postoperative complications; reduction of hospital stays and treatment costs.

It should be noted that at present, in most developed countries, inadequate postoperative pain relief is considered a violation of human rights and is carried out in accordance with accepted national and international standards. In our country, many clinics have introduced a formulary system for using medical preparations certain groups, the expediency of which is confirmed by data evidence-based medicine, as well as due to the needs and characteristics of a particular medical institution. Many authors believe that all surgical units, as well as departments of anesthesiology, resuscitation and intensive care should have in their arsenal only those analgesics and anesthetics, the effectiveness and safety of which is confirmed by evidence of I (systematized reviews and meta-analyzes) and II (randomized controlled trials with definite results) levels (Table 1).

Table 1. Drugs, the use of which for postoperative pain relief is justified by evidence-based medicine (Acute Pain management: Scientific Evidence, 2- nd edition, 2005).

* infiltration of wound edges, intrapleural injection, prolonged blockade of peripheral nerves and plexuses, prolonged epidural analgesia.

World experience in postoperative analgesia allows us to identify the following main current trends in the fight against PBS:

Widespread use of non-opioid analgesics - non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol; in various European clinics, the frequency of prescribing these drugs as the basis for postoperative pain relief ranges from 45 to 99%;

Limitation of the use of opioid analgesics, especially the intramuscular version of their administration, due to the low efficiency and a significant number of side effects of this technique;

Widespread use of high-tech methods of pain relief - prolonged epidural analgesia by infusion local anesthetics, as well as patient-controlled intravenous or epidural analgesia.

The multimodal nature of postoperative pain relief, i.e., the simultaneous administration of several drugs or methods of pain relief that can affect various mechanisms of pain syndrome formation.

The duration of postoperative analgesia is a rather variable value and depends both on the intensity of pain afferentation and, consequently, on the trauma of the surgical intervention, and on the patient's individual tolerance to pain. The need for targeted relief of PBS arises, as a rule, during the first 4 days of the postoperative period (Table 2).

Table 2. The need for pain relief after operations of various volumes.

Clearly, there is currently no ideal analgesic or treatment for acute postoperative pain. Related to this is the very presence in clinical practice of a whole list of possible methods relief of PBS (Table 3). Nevertheless, even if there is a whole arsenal of means and methods of postoperative pain relief, from the standpoint of common sense it would be logical to assert that the prevention of nociceptive stimulation leading to the development of pain, primarily by the introduction of NSAIDs, is much easier and requires less medical costs than the fight with severe pain already developed. So, back in 1996 in Vancouver, the method of preventive (preventive) analgesia with the perioperative administration of NSAIDs was recognized promising direction in pathogenetic therapy pain syndromes and is widely used by progressive clinics at the present time.

Table 3. Methods and means of postoperative pain relief.

Below are the main means and methods of pain relief used in the modern surgical clinic in terms of the balance of their effectiveness and safety.

Opioid analgesics.

This group of drugs has been considered the drug of choice for the treatment of PBS for decades. However, at present, opioid analgesics are by no means the "gold standard" in the treatment of patients with acute pain. However, according to a number of domestic and foreign experts, the effectiveness of pain relief in traditional purpose opioids as monotherapy does not exceed 25-30%. However, the gradual withdrawal from excessive adherence to opioids in the postoperative period is associated not so much with their lack of effectiveness, but with a number of serious side effects that occur during their use (Table 4).

The main side effect associated with the use of natural opioids (morphine, promedol, omnopon) is depression of the respiratory center. The main problem is that the effective analgesic dose is often close to that which causes respiratory depression. In addition to respiratory depression, increasing the dose is limited by an increase in the frequency of other side effects, such as depression of consciousness, pruritus, nausea and vomiting, impaired intestinal motility, and difficulty in spontaneous urination in the postoperative period. It should be noted that it is in abdominal surgery that all negative effects opioids are manifested to a greater extent than in other areas of surgery. This is primarily due to their negative influence on the motility of the gastrointestinal tract, which occurs (albeit to a lesser extent) with the epidural administration of small doses of morphine. The latter circumstance was one of the reasons for the decline in popularity of postoperative epidural analgesia using hydrophilic opioids observed in recent years.

From the point of view of pharmacodynamics, opioid analgesics are agonists or antagonists of various types of CNS opioid receptors (mu-, delta-, kappa-). Drugs of the opioid group activate the endogenous antinociceptive system (central analgesia), but do not affect the peripheral and segmental non-opioid mechanisms of nociception and do not prevent central sensitization and hyperalgesia. Attempts to increase the effectiveness of analgesia and reduce the incidence of side effects of opioid analgesics are based on varying the methods of their administration (including in one patient): intravenous, intramuscular, epidural, transdermal, sublingual, rectal. The most common, but also the most unsafe and least effective way of administering opioids is intramuscular injection. This technique most often leads to inadequate pain relief - more than 60% of patients note the poor quality of postoperative analgesia. The reasons for this lie in the fact that all patients are administered fixed doses at standard time intervals, without taking into account individual variability in pharmacokinetics; often opioid injections are made with long interruptions, that is, when the pain syndrome is already expressed and its relief, by definition, becomes ineffective. It is at intramuscular injection Opioids most often develop respiratory depression, possibly associated with cumulation of the drug.

Table 4. Opioid analgesics for the relief of postoperative pain.

Significantly fewer side effects are caused by the use of the semi-synthetic opioid tramadol. Tramadol hydrochloride is an analgesic that mediates the analgesic effect both through opioid receptors and by inhibiting the noradrenergic and serotonergic mechanisms of pain transmission. Tramadol is characterized by relatively high bioavailability and long-term analgesic effect. However, the analgesic effect of tramadol is lower than that of morphine and promedol. A significant advantage of tramadol compared to other opioid analgesics is the extremely low degree of addiction and the minimal narcogenic potential of this drug. Unlike other opioids, in equianalgesic doses, tramadol does not cause constipation, does not depress blood circulation and respiration. Nevertheless, tramadol is also characterized by the development of nausea, dizziness, and in rare cases, vomiting.

It should be noted one more important aspect limiting the use of opioid analgesics in domestic clinical practice. The use of opioid analgesics for postoperative pain relief in Russian Federation strictly regulated by the existing orders of the governing bodies of public health. For example, Order No. 257 of the Moscow Department of Health of 2004 determines, in particular, the standard for the consumption of opioid drugs in ampoules per 1 bed in various surgical departments per year. Prescribing an opioid drug as in surgical department, and in the intensive care unit in most health facilities is accompanied by a colossal amount of formal difficulties, which often leads to the refusal of medical staff to use local drugs even when opioids are required. By topics the same reasons modern method the use of opioids - patient-controlled analgesia, most focused on the individual needs of the patient in pain relief - is not widely used in Russia.

non-opioid analgesics.

The term "non-opioid analgesics" refers to a group of drugs that differ in chemical structure, pharmacodynamics and, accordingly, the mechanism of pain relief, used to relieve PBS with parenteral, less often oral, administration. The drugs of this group, used both in the monovariant and as an adjuvant therapy, have different analgesic potential and a set of side effects (Table 5).

Table 5. Non-opioid analgesics for the management of postoperative pain.

From the data presented, it becomes obvious that the non-opioid analgesics listed in the table are used only as a possible addition to basic opioid therapy, the use of these drugs for the relief of PBS in the monovariant is not practiced.

Formally, the group of non-opioid analgesics also includes non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen (paracetamol). However, due to the significant demand in the modern surgical clinic, these drugs are now considered as separate subclasses of drugs for the relief of PBS.

Paracetamol.

Despite the fact that acetaminophen (paracetamol) has a history of more than half a century of use as an analgesic and antipyretic, the exact mechanism of action of this drug is still not known. Assumes central mechanism the action of paracetamol, including: suppression of the activity of type 2 cyclooxygenase in the central nervous system, which is associated with the prevention of the development of secondary hyperalgesia; suppression of the activity of type 3 cyclooxygenase, the existence of which is assumed and which, apparently, has a selective sensitivity to paracetamol; increased activity of descending inhibitory serotonergic pathways at the stage of pain modulation.

The possibility of using paracetamol as a means to combat PBS appeared with the introduction into clinical practice dosage form this drug for intravenous infusion (Perfalgan®). Intravenous administration paracetamol is used, as a rule, as a basic component of multimodal postoperative analgesia in various areas of surgery: traumatology, gynecology, and dentistry. Analgesic effect of 1 g of intravenous paracetamol with 10 mg of morphine, 30 mg of ketorolac, 75 mg of diclofenac and 2.5 mg of metamizole. Currently, in European clinics, 90-95% of patients receive paracetamol in the postoperative period. Usually the drug is administered intravenously during the operation, about 30 minutes before the end of the operation, which ensures a calm, painless awakening. Repeatedly paracetamol is administered after 4 hours, and then every 6 hours, up to 4 g per day. It must be emphasized that the analgesic effect of paracetamol is fully manifested only when it is used as a component of multimodal analgesia, that is, when it is combined with other analgesics, including - as part of combined preparations - Zaldiar® and Forsodol®, which contain paracetamol and tramadol (the drug is available only in tablet form, which often makes its use in the immediate postoperative period impossible). According to domestic experts and based on their own observations, the use of intravenous paracetamol in the monovariant does not effectively stop PBS.

Potentially dangerous side property paracetamol is a hepatotoxic and nephrotoxic effect, which can occur when the dose of 4 g / day is exceeded, especially if the patient has an initial impaired liver and kidney function. Restrictions on the use of paracetamol are: hepatocellular insufficiency with laboratory manifestations (increased levels of transaminases), kidney failure, alcoholism, alimentary insufficiency, dehydration.

local anesthetics.

The most important task of multimodal analgesia is to interrupt the afferent flow of nociceptive stimuli from peripheral pain receptors in organs and tissues to segmental structures of the CNS ( back horns spinal cord). This problem can be successfully solved using various methods of regional and local analgesia. An important role in expanding the use of methods of regional analgesia was played by the emergence of modern local anesthetics (bupivocaine, ropivocaine), as well as the detailed development of the technique of regional blockades.

Epidural analgesia occupies a key position among all regional methods of postoperative pain relief. During this procedure, a catheter is placed in the epidural space at the level of the thoracic or lumbar spine, through which local anesthetics are administered as a bolus or continuous infusion. Epidural anesthesia is both a means of providing analgesia during surgery (including in the monovariant) and a means of stopping PBS. Numerous studies have proven fundamentally more high efficiency prolonged postoperative epidural analgesia compared with systemic administration of opioid analgesics. As mentioned above, opioid analgesics themselves can also be used for epidural anesthesia. It is known that the epidural administration of local anesthetics and opioids significantly exceeds the analgesic effect of using these drugs separately. However, the epidural administration of opioids itself is fraught with serious side effects ranging from respiratory depression to severe skin itching. To date, it is generally accepted that the benefits of epidural administration of opioid analgesics in abdominal surgery do not outweigh the risk of complications of the epidural technique itself compared to parenteral administration of similar drugs.

In addition to the actual analgesic effect, the positive effect of postoperative prolonged epidural analgesia is to interrupt descending sympathetic efferent impulses, resulting in an improvement in visceral blood flow (activation of reparative processes in the intervention area), an increase in the activity of the parasympathetic nervous system (resolution of paresis of the digestive tube).

From an evidence-based perspective (Acute Pain Management: Scientific Evidence, 2-nd edition, 2005), the benefits of prolonged epidural analgesia include: better pain relief compared to parenteral opioids; improvement in gas exchange rates and a decrease in the incidence of postoperative pulmonary complications compared with opioid analgesia; acceleration of the recovery of the function of the gastrointestinal tract after abdominal operations and a decrease in the frequency of local complications.

Nevertheless, epidural anesthesia has a number of significant limitations. Epidural anesthesia itself is a complex invasive procedure, potentially dangerous in terms of the development of both local (infectious process, damage to the nerve roots, vessels of the arachnoid, dura mater) and systemic complications (respiratory depression, cardiotoxic effects, arterial hypotension). In this regard, epidural anesthesia requires the anesthetist to have special skills and constant monitoring of the patient's condition in the intensive care unit, less often in the surgical unit.

In recent years, the technique of long-term infusion of local anesthetics into the cavity of the surgical wound has become increasingly popular. A number of studies have shown that continuous infusion of local anesthetics over 24-48 hours through a wound catheter can improve pain relief and reduce the need for opioid analgesics. The works of domestic authors have shown that prolonged local anesthesia of the surgical wound due to the resorption of the local anesthetic and its presence in plasma at low concentrations can have a systemic anti-inflammatory effect. As in the case of epidural analgesia, the effect of local anesthetics in this case is due to the blockade of not only nociceptive pathways, but also sympathetic innervation. Speaking about the use of prolonged local anesthesia surgical wound, it should be noted that this technique is currently at the stage of clinical testing and its widespread implementation initially limits the obvious risk of exogenous infection of the wound and the real danger of systemic toxic effects of local anesthetics (arterial hypotension, arrhythmias, respiratory depression) due to their resorption by tissues.

Multimodal perioperative analgesia.

From the above characteristics and, more importantly, the shortcomings of the means and methods for the relief of PBS, the obvious conclusion is that at present there is no ideal analgesic or method for the treatment of acute postoperative pain. However, it is quite possible to get closer to solving the problem of the adequacy of postoperative analgesia by implementing the concept of multimodal perioperative analgesia in the clinic, which involves the simultaneous administration of two or more analgesics and / or methods of pain relief that have different mechanisms of action and allow achieving adequate analgesia while minimizing side effects before, during and after surgery (see Fig.).

Multimodal analgesia is currently the method of choice for postoperative analgesia. Its basis is the appointment of non-opioid analgesics (primarily NSAIDs), which in patients with pain of moderate and high intensity is combined with the use of opioid analgesics, non-opioid analgesics and methods of regional analgesia. The choice of one or another scheme of multimodal analgesia is determined primarily by the traumatic nature of the surgical intervention (Table 6).

Table 6 Variants of schemes of multimodal perioperative analgesia, focused on the trauma of surgical interventions.

Pain after surgery is a serious problem for any person, especially those with a low pain threshold. Any surgical intervention is a colossal stress for the human body, and pain is the result of a violation of the integrity of organ tissues. It is important to understand that severe pain is a natural phenomenon in the postoperative period, but their completion cannot be stoically tolerated. To relieve pain, the doctor without fail prescribes powerful painkillers in order to improve the patient's condition and shorten the duration of the postoperative recovery period.

The usual pills available in the home medicine cabinet are not very effective in this case. At the very beginning of the postoperative period, only injections, that is, injectable forms of medicines, can stop the pain. Further, tablet forms can also be used, but only after agreement with the doctor.

Classification of painkillers

All modern painkillers can be divided into 2 large groups: non-narcotic and narcotic. Among the narcotic (opioid) analgesics known:

• means of natural origin - Codeine, Morphine;
• semi-synthetic - Ethylmorphine, Omnopon, Morfilong;
• synthetic -, Nabulfin, Tramadol.

Drugs of the narcotic series have the following properties.

1. Strong analgesic effect, which is especially valuable in the postoperative period.
2. Certain psychotropic effects (a state of satisfaction and euphoria), which is the basis for the development of drug dependence and a limited duration of use of these drugs.
3. Severe side effects may develop, such as impaired cardiac activity and respiration, increased intestinal tone and Bladder, the occurrence of vomiting.

On the other hand, with short-term use (1-3 days) of narcotic analgesics and choosing the right dose for a particular patient, the likelihood of side effects is low, and high efficiency in terms of pain relief after surgery. Any opioid analgesics are dispensed in a pharmacy only with a special medical prescription.

Non-narcotic painkillers have a much less pronounced analgesic effect. However, the actual analgesic effect is combined with anti-inflammatory and antipyretic, which is no less important in the period after surgery. The following painkillers of this group enjoy the greatest and well-deserved popularity:

NSAIDs are first-line drugs for the treatment of inflammatory diseases of the musculoskeletal system, as well as proper painkillers for patients after surgery. The undoubted clinical efficacy of NSAIDs is limited by serious side effects (formation of ulcers on the gastrointestinal mucosa, kidney damage).

One of the advantages of non-steroidal analgesics for the patient is the convenient form of release: there are both injections and tablets. It is not uncommon to start with an injectable form of NSAIDs, which has a faster and more pronounced analgesic effect, and then the patient can switch to tablets and take them as needed.

Brief description of analgesics

Narcotic analgesics

Morphine

Morphine injections can eliminate or significantly reduce any pain, including after surgery in a patient with a low pain threshold. Morphine begins to act within 5-10 minutes after administration, its effect persists for 3-5 hours.

Morphine can successfully cope even with pain that has not been stopped by other analgesics. Therefore, you should not start pain relief with Morphine - it is better to leave it in reserve, for example, after surgery for oncological process. Morphine is contraindicated in patients:

• with severe hepatic and respiratory failure;
• epilepsy;
• in a state of extreme intoxication.

They produce both an injectable form of Morphine and tablets. The tablet form is almost equivalent to the injection in terms of the strength of the analgesic effect.

Omnopon

It is a mixture of several opiates, including Morphine. The indications are the same as those of Morphine, that is, Omnopon has almost the same strong analgesic effect. Unlike Morphine, Omnopon is somewhat less likely to cause smooth muscle side effects. Currently, only the injectable form of Omnopon has been created.

Promedol

It is a synthetic analogue of Morphine. It has a slightly less powerful and less prolonged analgesic effect in comparison with Morphine. In terms of its side effects, it is almost identical to Morphine, but it depresses the respiratory center to a lesser extent.

It is this property of Promedol that allows it to be used in cases where Morphine itself is contraindicated, for example, after surgery for multiple injuries or in a patient with severe pathology respiratory system. They produce an injectable form of Promedol and tablets.

Tramadol

Synthetic opioid analgesic. It has a powerful analgesic effect that persists for a long time (up to 8 hours). Tramadol tablets and injection solution are equally effective. Tramadol, unlike other opiates, is well tolerated with almost no side effects. Its use is not recommended for persons in a state of intoxication, women during pregnancy.

Non-narcotic analgesics

They are traditionally used after opioids, as they have a less pronounced analgesic effect, so they cannot eliminate severe pain on the first day of the postoperative period. After surgery, drugs are usually prescribed in injectable form, and then it is recommended to use tablets.

Deservedly called the "gold standard" among non-steroidal painkillers. It is quickly absorbed when taking tablets, begins to act after 30-40 minutes. It penetrates well into all organs and tissues, which ensures its effectiveness in the postoperative period in almost any type of surgical intervention.

Combined use justified various forms release: Diclofenac injections are first prescribed (2-3 times a day), as the pain decreases, the patient can switch to tablets.

A significant disadvantage of diclofenac is the range of its side effects, first of all, ulcerative lesion mucosa of the digestive tract, especially with repeated and prolonged use.

Nimesulide

Refers to more modern and safe painkillers. Less aggressive than Diclofenac. The analgesic effect is quite comparable with the "gold standard", even with a single injection, patients note a rather long duration of its action. A significant disadvantage of Nimesulide is the lack of an injectable form, which makes it difficult to use it in the early postoperative period. In addition, with prolonged and repeated use of Nimesulide, the likelihood of side effects increases.

Rofecoxib

One of the most modern painkillers, combining reliability and duration of action, safety and ease of use. Pharmaceutical companies produce injections and tablets of Rofecoxib, which makes it possible to use it in the period after surgery. An important feature of Rofecoxib is its safety: it does not damage the gastrointestinal mucosa, so it can be prescribed to a patient with peptic ulcer. It has a long half-life, meaning that a single dose of either form of release is sufficient to significantly reduce pain.

The current generation is very often prone to problems with the spine. Osteochondrosis, or rather, degenerative changes intervertebral discs, lead eventually to the formation of a hernia. In this case, the disease that has arisen can no longer be healed; surgery can only be used. But, unfortunately, not everything is so simple, the pain after spinal hernia surgery may not leave you, but only intensify. Even after removal intervertebral hernia leg numbness may occur. It is important to understand that the recovery process does not stop during the operation, rehabilitation is also an important component of a full recovery.

Importance of the rehabilitation process

After surgery, complications can form not only in the place where the hernia is located, edema often forms on the leg after surgery. The back will constantly hurt, the foot will also be very sensitive or, conversely, numb so that it will be difficult for you to walk. This condition does not happen to everyone who has gone through such treatment.

Surgical intervention can lead to certain consequences. Therefore, rehabilitation is aimed at helping the patient, who has not yet completely got rid of the pain syndrome or other neurological manifestations.

Since the intervertebral disc was displaced by a hernia, rehabilitation after the operation is also important for restoring the biomechanics of the vertebra itself. It is important for him to regain mobility, because this is your frame, your strength.

You must understand that surgery is not the end result of your complete recovery. Doctors say that the main task can be called the correct selection complex rehabilitation in order to successfully restore not only the mobility of the vertebra, but also to tone the muscles, all this together guarantees a complete recovery.

Once the surgeons have done their job, the patient feels liberated. The pressure in the region of the vertebrae has passed, the swelling and pain have also disappeared. But often such a state of bliss does not last long, it happens in case of irresponsibility on the part of the patient, in case of non-fulfillment and incomplete observance of the doctor's recommendations, with the wrong way life.

If a person has a hernia, the recovery process is divided into three main periods.

1. The first stage is very short in terms of time - early, lasts no more than two weeks. The most important on this stage is the rapid elimination of pain, most often attention is paid to the psychosomatic support of the patient.
2. The next stage is late, occurs two weeks after the operation and lasts until the eighth. All attention should be directed to helping the patient in full recovery movements so that a person can take care of himself without resorting to the help of outsiders.
3. The delayed period is the latest, as it occurs two months after the operation to remove the herniated vertebrae.

Over time, the body is fully restored, but in the postoperative period, it is important to follow the prevention so as not to get sick again.

Why does intraosseous pressure increase?

Due to excessive and prolonged increase in bone pressure in the spine, this condition leads to irritation of the receptors located in the middle of the bone itself. As a result, the pain threshold decreases. In such unfavorable conditions, the impulse passes through the already formed hernia and becomes suprathreshold and palpable.

A very painful impulse passes directly through spinal cord, getting into the head. Because of this, the disease takes on a very dangerous condition. People who have undergone manipulations to remove the formation may feel pain during recovery.

Why is this happening? Everything is very simple, scar tissue on the spot stitching makes itself felt. This happens with an increase in intraosseous pressure or with irritation of bone receptors.

recovery program

In order to choose the right complex of necessary manipulations to restore mobility and full-fledged general health of the patient, doctors take into account many factors. First of all, the treatment depends on the method of the operation, if it was traditional, then the healing process is quite long, it can reach six months.

With minimally invasive methods, healing occurs much faster. Age, body characteristics and other factors are also important. physiological indicators. If you follow the following points during rehabilitation, the treatment will be more effective:

• Treatment with medication.
• Selection of a complex of physiotherapy exercises (LFK).
• Physiotherapy.
• Treatment at health resorts and sanatoriums.
• Procedures with the use of water.

Not only the back, but also the leg or even both can hurt after surgery. Therefore, it is very important to listen to the recommendations and opinions of experts.

Treatment should always be under the strict supervision of a doctor in a hospital. Medicines are taken in cases where any complications are observed. Then doctors prescribe painkillers and anti-inflammatory drugs intravenously or intramuscularly.

Since the spine is weak after the operation, the patient must wear a special slimming and supporting corset. Chondoprotectors and decongestants are also used in the treatment.

Some moments in the recovery process

As you know, therapeutic exercises very helpful in quickly restoring mobility and regaining lost muscle tone back, neck and limbs. If you use only properly selected exercises, you can improve blood circulation and all stagnant processes will stop developing. The adhesions and swelling will go away. The leg can also hurt - this is one of the unpleasant consequences after the operation, so it is important to obey your doctor.

However, the patient must remember the seriousness of the manipulations performed on the back and perform all exercises smoothly, slowly and slowly. It is strictly forbidden to make sharp bends, turns or twists.

If, when performing a set of exercises, you feel discomfort in the back or your leg is disturbed, you should reduce the load. When you feel painful symptoms stop your activity completely. Consult your doctor, perhaps he will advise another exercise technique.

Surgical interventions are always a dangerous and unpredictable event, but in some cases, unfortunately, you can’t do without it. Therefore, do not start the appearance of symptoms and pain in the vertebra, immediately seek help from a doctor and perhaps you will have enough conservative methods treatment.

After all, if you had such a problem once, then if all the recommendations are not followed, it can happen again. Everything is in your hands and it depends only on you whether you will suffer from pain or not.

The meniscus is a cartilaginous lining. It stabilizes the knee joint, acting as shock absorbers. During movement, the meniscus changes shape and contracts.
The menisci of the knee joint can be of two types: internal, or medial and external, or lateral.
The medial meniscus is less mobile and is often subject to injury. Lateral - more mobile, it is very rarely susceptible to damage.

Functions of cartilage pads

Menisci are designed to maintain the integrity of the joints, to ensure their normal operation.

The main functions include the following:

• the meniscus limits the excessive mobility of the joints;
• cushioning function - with any movement, the cartilage pad changes shape and thickness, due to this, the load on the cartilage is reduced;
• The menisci greatly reduce friction between the surfaces of the bones that enter the joint.

In this article, we tell you how to diagnose and treat a dislocation of the hip joint.
Why does pain occur and how does it manifest itself? hip joint, can be found here
Read more about hip pain during pregnancy here.

Types of damage

Why are menisci injured?

Usually they are damaged as a result of various injuries.

There are several major contributing factors to cartilage pad disease.

These include:

• diseases of the joints of the knees, which are worn chronic, these include rheumatism or gout,
• falling on straight legs
• strong blows to the knee area, during which the leg turns outward or inward,

• flat feet,
• pathologies of the knee joints, which are congenital in nature;
• degenerative processes occurring in cartilage tissues.

Symptoms

Often, the symptoms are non-specific, and, based on them, damage can be confused with other diseases of the knee joint. If the injury was moderate or mild degree severity, then only after one to two weeks it is possible to speak with confidence about injury to the meniscus.

The patient will be disturbed by the following symptoms:
• difficulty when a person goes up or down stairs,
• pain on the inner or outer surface of the knee,
• pain during exercise, sports,

• during flexion of the joint, a special click is heard,
• an increase in body temperature in the affected area.

If a person has been severely injured, the symptoms of a meniscus injury will be as follows:

1. Upon impact, the victim hears a characteristic click, after which he feels acute attack pain.

2. The next day after the injury, the pain is felt with renewed vigor, practically immobilizing the victim.

3. The knee joint swells. There is redness and an increase in the temperature of the skin.

Diagnostics

The diagnosis is established based on the patient's complaints. Instrumental studies are prescribed to determine the severity and type of damage.

The doctor can use the following diagnostic methods:

• Baykov's symptom - the knee is bent at a right angle, while the doctor palpates the joint space and passively extends the joint. Pain indicates damage to the meniscus.
• Chaklin's symptom - it includes a "click" symptom and a sign of the tailor muscle.
• Steiman's symptom - the knee must be bent at an angle of 90 degrees. Then the doctor makes rotational movements of the lower leg. When painful sensations are fixed damage.

The following studies will help confirm the diagnosis:

X-ray - menisci are not visible on ordinary pictures. X-rays with the introduction of a special contrast medium. But this method is practically not used, since it has been replaced by more convenient and informative research methods.

MRI is a common diagnostic method based on nuclear magnetic resonances. This method helps to specify the damage. MRI does not require special training. During the examination, the patient will have to lie quietly without moving.

There are 4 degrees of changes (classification according to Stoller):
• 0 - meniscus unchanged,
• 1 - in the thickness of the meniscus there is a focal signal that does not reach the surface of the meniscus,
• 2 - in the thickness of the meniscus there is a casting signal that does not reach the surface of the cartilage lining,
• 3 - the presence of a signal reaching the surface of the meniscus (this is considered a true break).

Ultrasound examination is an informative diagnostic method. It does not require preparation, the only condition is that intra-articular injections should not be given a few days before the ultrasound. Ultrasound has a number of advantages: the procedure is harmless, operative, does not damage tissues, and is affordable.

First aid

If there is a suspicion of a rupture of the meniscus of the knee joint, then you need to immobilize the limb - to ensure complete immobility. The limb is immobilized in the position in which the joint was blocked.

After immobilization, an ice compress should be put on the joint, it constricts blood vessels and reduces pain. Keep ice on the affected knee for 10 to 30 minutes.

Painkillers

If the victim complains about unbearable pain after an injury, he may take painkillers.

These include:

1. Non-steroidal anti-inflammatory drugs - medications that relieve pain, relieve inflammation. They are represented by: Diclofenac (from 11 rubles), Ketaprofen (from 39 rubles), Indomethacin (from 17 rubles), Naproxen (from 77 rubles). Contraindications - peptic ulcer, pregnancy, lactation, epilepsy, bronchial asthma, thrombocytopenia, heart failure.

• Opioid receptor agonists are drugs that regulate pain. This group includes Promedol (price from 264 rubles).

Contraindications - respiratory failure, individual intolerance, hypertension, bronchial asthma, heart rhythm disturbances, problems with blood clotting.

Conservative treatment

The first step is to eliminate the blockade of the knee joint. The doctor punctures the damaged joint, removes the contents from it (it can be blood or effusion). Then the victim is given local anesthesia by injecting novocaine or another drug.

How to remove the blockade

Before the procedure, the patient is seated on a high chair. The angle between the thigh and lower leg should be ninety degrees.
1. At the first stage, using a special device, the doctor stretches the patient's foot.
2. The doctor deviates the lower leg to the side that is opposite to the damaged meniscus. In doing so, he can take a natural position.
3. The doctor performs rotational movements, with which he turns the lower leg in and out.
4. At this stage, free extension and flexion of the injured knee is performed. The movements are effortless.

Drug therapy includes taking non-steroidal anti-inflammatory drugs, chondoprotectors, rubbing with ointments and intra-articular injections.

UHF therapy

This is a physiotherapeutic method in which the affected area is affected by an electric field of ultra-high frequency. This method improves the blood supply to the damaged joint. It has analgesic, anti-edematous and anti-inflammatory effects.

Physiotherapy

It is a complex special exercises aimed at restoring a damaged joint. With an immobilized knee, you need to perform general strengthening exercises that develop all muscle groups. It is important to use your healthy leg. There are also special physical activities with a sore leg: it is necessary to strain the muscles of the thigh, raise the leg, giving it an elevated position, in order to prevent venous stasis of blood.

In this article, we talk about the features of gymnastics for osteoporosis, and also offer photo and video sets of exercises.
How to help yourself with a hernia with exercise lumbar spine read here

Massage
This method is one of the most effective methods conservative treatment if there is damage or rupture of the meniscus of the knee joint. It improves blood circulation, reduces pain and swelling. Massage restores muscle tone, improves muscle elasticity.

Reception of chondoprotectors
Drugs in this group contribute to the restoration of cartilage tissue. They are prescribed if the patient has not only damaged the meniscus, but damage to the cartilage tissue has also been recorded. The main drugs include the following: Glucosamine, Chondroitin, Rumalon.

Treatment with folk remedies

• Within 10 days, a bile compress is applied to the injured knee.
• To folk remedy includes a compress of honey and alcohol, taken in a ratio of 1 to 1. Apply it at night, wrap it with a warm cloth on top.
• Wrap your knee in burdock leaves. Fix with a bandage and hold for 4 hours.
• Chop the onion, mix with sugar. Apply a compress to your leg for 30 days.

Operation

If the blockade of the knee cannot be eliminated, then surgical intervention is indicated for patients. The operation is performed if the body or horns of the meniscus are torn or the cartilage tissue is crushed, a rupture of the meniscus with its displacement is recorded.

Surgical treatment can be carried out in different ways:
• Arthrotomy is an operation on the knee joint, in which viral formations are removed. The operation is done under general anesthesia.
• Meniscectomy - removal of the meniscus, may be partial or complete.
• Partial meniscectomy - incomplete removal of the cartilage lining.
• Transplantation - transplantation of a donor meniscus.

Arthroscopy is one of the safest operations, during which the damaged meniscus is stitched together. The doctor sees the entire joint as a whole. Stitching is done using an arthroscope. All two small holes remain on the human body after the insertion of the device. average cost operations from 17,000 rubles.
Surgery is performed in people whose age does not exceed 45 years.

Rehabilitation

Rehabilitation begins 5-7 days after surgery. It will help with a quick recovery.

Physiotherapy recovery options include:
• UHF therapy - a high-frequency electromagnetic field acts on the human body. UHF improves blood flow, lymph circulation. This method of rehabilitation helps with inflammatory processes,

• Magnetotherapy - the effect on the patient's body of a statistical magnetic field. The rehabilitation method improves immunity, blood supply to the affected joint.
• Electrophoresis of anesthetic drugs is a method in which an anesthetic drug easily penetrates into the operated joint by means of an electric current.

In addition to physiotherapeutic procedures, patients after surgery should be prescribed physiotherapy(exercises are assigned individually) and massage of the diseased joint.

Full recovery occurs 2-3 months after surgery.

It depends on a number of factors:
• age category of patients,
• duration of meniscal injury
• degree of damage
• surgical method,
• condition of the ligaments (are there any pathological changes).

The best ointment for knee joints: which one to choose for knee pain

Knee pain is a terrible feeling that prevents you from leading a fulfilling life. Naturally, it must be fought. For this, not only oral medications are used, but also ointments. They contribute to the restoration of cartilage tissue, the resumption of normal mobility. However, it is necessary to consider what ointments are, how to use them correctly.

Why does knee pain occur?

Before treating knee pain, it is necessary to consider the causes of its occurrence. It depends on which type of cream or ointment is best suited. So, there are such reasons for the appearance of pain:

• Gonarthrosis. It is characterized by the destruction of the cartilage tissue of the knee joint.
• Bursitis. Inflammation synovial bag joints.
• Rheumatoid arthritis. This is a common inflammatory disease of the joints of the legs as well as the hands.
• Gout. It is characterized by the accumulation of uric acid salts mainly in the joints of the legs.
• Meniscus injury.
• Leg injuries.
• Cyst or tumor.
• Excessive stress due to sports training or large body weight.

These reasons are not the only ones. Any malfunction in the body can provoke pain, swelling, redness of the knee joint. However, before you run to the pharmacy and buy an ointment, you must definitely install exact reason development pathological condition. Therefore, you will have to turn to a surgeon, traumatologist, orthopedist and rheumatologist.

Varieties of ointments used

All ointments and gels for the treatment of knee joints of the legs can be classified as follows:

• Anti-inflammatory. Thanks to them, the very possibility of pain can be eliminated.
• Warming. They activate blood circulation and metabolism in the affected area.
• Chondroprotectors. These funds nourish and restore cartilage tissue.

Naturally, it is necessary to treat the pathology and restore the mobility of the knee joint. But you also need to know which ointment, cream or gel is best to use. After all, the wrong remedy simply will not help. It is better if the doctor decides on the drug.

Features of NSAIDs

Non-steroidal anti-inflammatory drugs are the basis of drug treatment for foot pathologies. They are able to significantly slow down the secretion of enzymes that cause the inflammatory process. That is, the pain does not appear at all. In addition, such gels and ointments reduce swelling of the knee joint. After the application of these funds, the function of bending the legs is restored.

It is necessary to apply such ointments directly around the area that hurts. The layer of the drug should not be thick. It is better to use it 1-2 times a day. But the knee can be treated with the presented preparations for no more than 2 weeks. If there are scratches or wounds in the affected area, then they should be avoided.

NSAIDs help within half an hour, and the effect lasts at least 5 hours. But if the selected cream did not help get rid of pain in 7 days, then you should consult a doctor.

In general, NSAIDs are well tolerated by the body, however, these products should not be used during pregnancy and lactation, as well as in case of a serious violation of the kidneys and liver, and an allergy to acetylsalicylic acid.

Among these drugs, groups of drugs can be distinguished based on:

1. Diclofenac ointments: "Diclofenac-acry", "Ortofen".
2. Nimesulide: "Nise".
3. Ketoprofen: Artrosilene.
4. Ibuprofen: Long. The presented preparations remove the stiffness of the knee joint, contribute to the restoration of flexion function.
5. Indomethacin.
6. "Bystromgel". It is prescribed for severe inflammatory processes in the area of ​​the knee joint. A feature of the drug is that for a greater effect, the affected area should be well massaged before applying.

Warming ointment: application features

So, if a person has knee pain when bending his legs, it is necessary to be examined. The pathological process can be serious. However, even a minor disease must be treated.

Since most pathologies support system contribute to impaired blood circulation in the affected area, it is better to use warming ointments. They have good reviews and have a quick effect. Due to the fact that warming creams promote vasodilation, the process of restoring the nutrition of cartilage and bone tissue is accelerated. Since blood flow to the diseased joint increases, heat appears in it.

You can use such ointments to eliminate pain after sports training or in the presence of a serious illness. You need to apply the product in a small layer, and to enhance the effect, you can wrap the knee joint with a warm scarf. After using such a cream, not only does blood circulation and nutrition of the joint improve, but the functions of flexion-extension of the legs are restored. The maximum duration of treatment is 10 days.

Before use, a certain amount of the substance must be applied to the skin and see what the reaction will be. It should be noted that vegetable ointments do not clean as well as factory ones. Therefore, they may contain natural allergens.

After training or with chronic orthopedic disease, the following ointments are used:

1. "Viprosal", "Nayatoks". Maximum effect during treatment, it has snake venom, which is part of these drugs.
2. "Apizartron", "Virapin". They are rich in bee venom, which is effective not only when the knees hurt, but also when the crunch in the joints.
3. Vegetable: Espol.
4. Synthetic factory products. Good feedback, especially in the elderly, as well as athletes has "Finalgon". This group also includes Kapsikam.

What are the benefits of chondroprotectors?

Chondroprotectors are special means, which are used to restore cartilage tissue damaged due to arthrosis of the knee joints. As the cartilage tissue wears out and breaks down over time, the bones begin to rub against each other, causing severe pain to a person. Therefore, the limb becomes limited in movement. To restore cartilage, components such as chondroitin, glucosamine and collagen are needed. It is they who are contained in the composition of the presented group of drugs.

These substances have a strong influence on the exchange of phosphorus and calcium in the body. Due to this, the progression of cartilage destruction slows down. Chondroprotectors are quite well perceived by the body and practically do not cause unwanted reactions.

To restore cartilage, the following drugs are used:

• "Chondroxide".
• "Chondroitin".
• "Artrin".

With crunch and pain in the knee joint, which indicate the development of arthrosis, chondroprotectors are the main drugs used in therapy.

Some folk recipes preparation of ointment for the knees:

1. Turnip based. First you need to select an unspoiled turnip, peel it and grind it to a pulp. After that, 100 g of honey and 20 g of vodka are added to it. The composition must be mixed well. Apply the product to the affected area several times a day.
2. Ointment from vinegar and eggs. To prepare the product, you will need a chicken egg along with the shell, as well as vinegar essence. First, the egg should be placed in a glass vessel. After that, the essence is poured into it, which should cover the egg. Next, the vessel must be placed in a dark nightstand for 5 days. During this time, the shell will completely dissolve, after which 200 ml of sunflower oil is added to the mixture, and it is exposed to the sun. Keep it there should also be about 5 days. After that, the tool is ready for use. It is necessary to rub it with light massage movements, after which the affected joint is wrapped with a warm scarf.
3. If a person has problems with flexion or extension of the knee joint, and there is also pain in it, then such an ointment will come in handy: glycerin, iodine, alcohol and honey are mixed in equal proportions, after which the composition should be infused for about several hours. Next, it is rubbed around the affected joint.

Good reviews can also be heard about Dikul's balms. They are used to treat gout, osteoarthritis and osteochondrosis. Dr. Dikul's ointment has a pronounced analgesic and anti-inflammatory effect.

In any case, no matter what the cause of pain in the knee joint is: training, injury or disease, the doctor should prescribe treatment.