[STAGES OF OPIOID THERAPY OF CHRONIC PAIN IN RUSSIA: ANCIENT AND COMING].

There is history of the introduction and development of systemic and invasive opioid treatment of chronic cancer pain in Russia presented by the authors--experts with experience in thisfield over 30 years. The earliest researchers are no more among us, but their memory is still alive in the publications of the early 1980's. Along with the analysis of accumulated by Russian specialists positive clinical experience of opioids using, authors discuss main problems of organization and availability of adequate opioid therapy of chronic pain in Russia. Ways of further development ofpalliative care and pain management in oncology is discussed as well as.

[First experience in the use of a new Russian narcotic analgesic prosidol in oncology]. / Pervyi opyt primeneniia novogo otechestvennogo narkoticheskogo analgetika prosidola v onkologii.

Prosidol, a new Russian narcotic analgesic, was used in various dosage forms (buccal and oral tablets, injection solution) in 113 cancer patients for the treatment of chronic pain, as a component of total anesthesia, and for postoperative analgesia. The best results were attained with the universal noninvasive dosage form, buccal tablets, used for the treatment of chronic pain in incurable patients. Analgesic properties of buccal prosidol are close to those of tramadol, the drug is well tolerated by the patients and causes no grave side effects. As a drug for postoperative analgesia prosidol was highly effective in patients after extracavitary oncologic surgery and less effective after thoracal and abdominal interventions. As a component of total anesthesia prosidol is inferior to fentanyl and approximately similar to promedol. An advantage of prosidol is its highly effective universal noninvasive dosage form, buccal tablets, which may be used for rapid analgesia in any situation.

[Norfin in oncological practice]. / Norfin v onkologicheskoi praktike.

A synthetic opiate agonist-antagonist norphin (buprenorphin) has been studied in 297 cancer patients as an analgetic component of general anesthesia, in postoperative analgesia and in the treatment of chronic pain syndrome. In modified neuroleptanalgesia based on norphin, diazepam, droperidol and N2O the patient is more adequately prevented from surgical trauma than in conventional neuroleptanalgesia based on fentanyl. This is confirmed by greater stability in circulation, metabolism and stress hormone parameters, however this anesthesia technique is less manageable and may be accompanied by prolonged postanesthesia depression of the central nervous system. Good results have been obtained when norphin pills were used sublingually for the treatment of long-lasting intensive chronic pain syndrome in incurable cancer patients. Norphin is no less effective than morphin, however, unlike morphin, it causes no severe adverse reactions.

[Last-generation synthetic opioid analgesics as alternative to opiates in oncologic surgery]. / Sinteticheskie opioidnye anal'getiki poslednego pokoleniia kak al'ternativa opiatam v onkokhirurgii.

The present-day problem is the development of effective methods of general anesthesia and postoperative anesthesia on the basis of nonopiate central analgesics possessing no hazardous side effects of opiates. A study was made of synthetic analgesics of the last generation as agents for intra- and postoperative anesthesia as compared with conventional opiates. It has been established that synthetic analgesics belonging to the class of opiate agonists-antagonists, namely moradol and norphine, compare favourably enough with fentanyl. They are superior to fentanyl in antistressor properties, provide for a more powerful and longer analgesic effect and can replace conventional opiates in all the stages of surgical treatment of the patients. This is particularly important for the oncological clinic where opiates are to be preserved as reserve for the treatment of chronic painful syndrome.

[The new Soviet narcotic analgesic phenaridine as a component of general anesthesia during cancer surgery]. / Novyi otechestvennyi narkoticheskii analgetik fenaridina kak komponent obshchei anestezii v onkokhirurgii.

The results of studies on 65 cancer patients operated on under modified neuroleptanalgesia using fenaridine give evidence of a more potent and prolonged analgetic effect of a new Soviet narcotic analgesic fenaridine as compared to fentanyl. Fenaridine ensures stable neuroautonomous protection of the body during cancer surgery and is indicated in prolonged traumatic surgical interventions with cardiopulmonary bypass. Along with the above advantages fenaridine possesses all the complex of side effects typical of opiates associated with the depression of respiratory centres, psychoemotional sphere, activation of parasympathetic centres which may complicate the period following the patient's withdrawal from anesthesia and necessitate prolonged controlled lung ventilation in the early postoperative period. Thus, during 3-5-hour-long surgery it is advisable to administer the basic amount of the overall drug dose during the first 1-1.5 h of anesthesia and surgery, which promotes the awakening of most patients 10-15 min after surgery. Another drawback of fenaridine is the onset of marked rigor and signs of microcirculation disturbances upon discontinuation of the drug effect.

[Reaction of the blood circulation and its oxygen transport function to the discontinuation of prolonged mechanical lung ventilation in heart surgery patients with an uncomplicated postoperative period]. / Reaktsiia krovoobrashcheniia i ego kislorodtransportnoi funktsii na prekrashchenie prodlennoi IVL u kardiokhirurgicheskikh bol'nykh s neoslozhnennym techeniem posleoperatsionnogo perioda.

The studies of changes in central hemodynamics and oxygen balance during discontinuation of controlled lung ventilation in 24 cardiosurgical patients with uncomplicated postoperative period have demonstrated 2 types of circulatory response to transition to adequate spontaneous respiration. It has been shown that an increase in O2 consumption due to the involvement of respiratory muscles is the main factor affecting the resetting of central hemodynamics and oxygen balance during transition to spontaneous respiration. While in patients with normodynamic type of circulation O2 increment is as a rule caused by an increase in cardiac performance, in cardiosurgical patients with hyperdynamic type of circulation O2 increment is mainly ensured by enhanced tissue O2 extraction.

[Tramal in the treatment of acute and chronic pain syndromes in cancer patients]. / Tramal v lechenii ostrogo i khronicheskogo bolevogo sindroma u onkologicheskikh bol'nykh.

The study of 65 cancer patients has demonstrated the advantages and disadvantages of tramal as an agent used for the relief of acute and chronic pain syndrome. In 18 patients tramal was used in postoperative analgesia, in 17 patients it was used for the treatment of chronic pain syndrome. It has been shown that in the postoperative period tramal has no noticeable advantages over promedol. However, tramal had definite advantages over other opiate agonists when used for the treatment of chronic pain syndrome in incurable cancer patients. Thus, the data obtained show that tramal, a synthetic analgesic of a new generation, has no dangerous side effects, is effective in a convenient, non-invasive drug form, interacts well with non-narcotic and supplementary agents and causes no clinical signs of drug tolerance or addiction in prolonged application.

[Methodologic approach to the discontinuation of long-term artificial ventilation in cardiosurgical patients with postoperative cardiac insufficiency]. / Metodicheskie podkhody k prekrashcheniiu prodlennoi iskusstvennoi ventiliatsii legkikh u kardiokhirurgicheskikh bol'nykh s posleoperatsionnoi serdechnoi nedostatochnost'iu.

Correction of postoperative heart failure by continuous dopamine infusion makes it possible to avoid a decrease in cardiac performance and development of inadequate oxygen tissue supply in the course of discontinuation of controlled lung ventilation. It has been demonstrated that in a number of cases it is necessary to increase the drug dose to prevent inadequate oxygen supply of organs and tissues in patients with exhausted tissue reserves.

[Synthetic analgesic moradol at various stages of surgical treatment of patients with cancer]. / Sinteticheskii analgetic moradol na étapakh khirurgicheskogo lecheniia onkologicheskikh bol'nykh.

Moradol ("Galenika", Yugoslavia)/butorphanol tartrate ("Bristol--Mayers C.", USA)/, a synthetic analgesic representing a new generation of opiate receptors agonists-antagonists, devoid of any narcogenic potential has been used as the only analgesic at all stages of anesthesia during cancer surgery in 26 patients. For premedication moradol was used in a mean dose of 0.032 +/- 0.003 mg.kg-1 in combination with diazepam (0.153 +/- 0.005 mg.kg-1) and atropine (0.01 mg X X kg-1). For induction to anesthesia moradol was used in a dose of 0.72 +/- 0.003 mg.kg-1 and diazepam in a dose of 0.27 +/- 0.015 mg.kg-1. General anesthesia was maintained with moradol, diazepam, nitrous oxide and droperidol. The data presented in the paper demonstrate the advantages of moradol at all stages of intra- and postoperative analgesia, which ensures stable anesthetic background (according to hemodynamic parameters) and reduces considerably an overall postoperative analgesic dose.

[The use of computers for diagnosis and control of the treatment of acid-base imbalance during controlled lung ventilation in patients following thoracic surgery]. / Primenenie EVM dlia diagnostiki i upravleniia terapiei narushenii kislotno-osnovnogo ravnovesiia v period provedeniia IVL u bol'nykh posle torakal'nykh operatsii.

An algorithm for diagnosis and control over therapy of acid-base imbalance during controlled lung ventilation in patients after thoracic surgery has been elaborated and described. Acid-base balance was studied 162 times in 32 patients after thoracic surgery. Automatic diagnosis and control over acid-base imbalance therapy rule out subjective interpretation of the findings obtained and make it possible, if necessary, to titrate accurately the dosage of correcting drugs and establish the priority of treatment procedures.