The purpose of the work was to determine the effectiveness of the infulgan with reumoxicam combination for postoperative analgesia in gerontologic patients with polytrauma. Materials and methods. We examined 32 patients over the age of 60 with a skeletal polytrauma who received as a postoperative analgesic combination of a central cyclooxygenase inhibitor (COG) infulgan with a peripheral COG inhibitor reumoxicam. The study was conducted on 1st, 3rd, 5th and 7th days after surgery. The level of pain by the visual analog scale (VAS), the concentration of stress markers, the mediators of the systemic inflammatory response (SIR), and the parameters of the system of regulation of the aggregate state of the blood (RASB) were determined. We took into account the daily need for analgesics, the frequency of their administration, the side effects of drugs for anesthesia, and the duration of effective analgesia. Results and discussion. It was discovered, that the need for opiates was low if analgesia was used. The observed side effects were related to the use of nalbuphine and were noted only in 2 (6.3%) patients: on the 1st day there was drowsiness and nausea. On the 3rd day these patients had only drowsiness. There were no side effects associated with analgesia in the rest of patients. The dynamics of the level of markers of stress (glucose and cortisol) was sufficient enough to suggest an equal analgesic effect of the combination of COG inhibitors and opiate analgesics. A significant decrease in the levels of these mediators was recorded after the 1st day of the postoperative period, and by the end of the study, they reached the normal level. On the background of COG inhibitor therapy, on the 1st day after the operation, the tendency to hypercoagulation did not increase, but, starting from the 3rd day, this trend significantly decreased, practically disappearing after the 5th day. Conclusions. Thus, the need for only small doses of opiates during the first 3 days after surgery, the decrease in the concentration of stress markers and a significant decrease in the manifestations of SIR show a high analgesic activity of the combination of COG-2 and COG-3inhibitors, the basis which is a pathogenetically determined influence on the mechanisms of SIR.

Keywords: analgesia, gerontologic patients, polytrauma, cyclooxygenase inhibitor, reumoxicam

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1. Seleznev SA, Bagnenko SF, Shapot YuB, Kurygin AA. Travmaticheskaya bolezn i ee oslozhneniya. SPb: Politekhnika, 2004. 414 р. [Russian]
2. Viktorov AP, Maltsev VI, Matveyeva EV, Logvina IA. Pobochnye deystviya lekarstv v pozhilom i starcheskom vozraste. Ratsionalnaya farmakoterapiya. 2007; 3 (04): 42-55. [Russian]
3. Chepkiy LP, Usenko LV. Heriatrychna anesteziolohiya ta reanimatsiya. K: Zdorov’ya, 1994. 256 р. [Ukrainian]
4. Volikov IA. Sravnitelnaya otsenka razlichnykh variantov uprezhdayushchey analgezii pri operatsiyakh u gerontologicheskikh bolnykh. Bіl, znebolyuvannya і іntensivna terapіya. 2008; 1: 48-53. [Russian]
5. Aktual'ni problemy herontolohiyi ta heriatriyi: materialy VII nauk konf molodykh vchenykh z mizhnar uchastyu, prysvyachenoyi pam’yati akademika VV Frol'kisa (Kyiv, 27 Jan 2006). K: In-t herontolohiyi, 2009. 139 р. [Ukrainian]
6. Skorokhod VM, Skorokhod TV. Vikova fiziolohiya ta valeolohiya. Kirovohrad: RVV KDPU im Vynnychenka, 2008. 224 р. [Ukrainian]
7. Korkushko OV, Asanov EO, Pysaruk AV, Chyzhova VP, Chebotar'ov MD. Vikovi osoblyvosti funktsiyi endoteliyu ta mikrotsyrkulyatsiyi u razi hipoksychnoho stresu. Krovoobih ta hemostaz. 2007; 2: 15-9. [Ukrainian]
8. Korkushko OV, Lishnevs'ka VYu, Duzhak HV. Vikovi osoblyvosti funktsional'noho stanu endoteliyu mikrosudyn. Krovoobih ta hemostaz. 2007; 4: 5-11. [Ukrainian]
9. Korkushko OV, Lishnevskaya VYu, Duzhak GV, et al. Vozrastnyye izmeneniya reologicheskikh svoystv krovi i funktsionalnogo sostoyaniya endoteliya pod vliyaniyem normobaricheskoy gipoksii. Zhurn AMN Ukraine. 2009; 15 (3): 488-99. [Russian]
10. Korkushko OV. Vozrastnyye izmeneniya serdechno-sosudistoy sistemy pri starenii: materіali Kh Nats kongresu kardіologіv Ukraine (Kyiv, 23-25 Sep 2009). Ukr kardіol zhurnal. 2009; 1: 233-7. [Russian]