title: [Analgesia in hemophiliac patients during orthopedic surgery].
abstract: OBJECTIVE
  To develop an effective and safe analgesic regimen (by minimizing the proportion of narcotic analgesics) in hemophiliac patients in the perioperative period during high-trauma surgeries (total knee and hip replacements).
  
  
  METHODS
  The prospective study included 24 patients aged 22 to 57 years (median age 38 years) with severe congenital hemophilia A (n = 22) and B (n = 2), who had undergone knee (n = 18) or hip (n = 6) replacements in the Hematology Research Center, Russian Ministry of Health of the Russian Federation, in 2013. Two analgesic regimens (a) paracetamol with trimeperidine; b) paracetamol and ketamine with trimeperidine) were used. To assess pain intensity, the authors used scoring scales: a visual analogue scale (VAS) and a numeric rating scale (NRS). The effect of paracetamol on hemostasis was evaluated on the basis of thromboelastogram and coagulogram readings. Possible paracetamol hepatotoxicity was assessed analyzing liver enzymes.
  
  
  RESULTS
  An interview has shown that 66% of the hemophiliac patients regularly take analgesics for chronic pain syndrome, among them 29% use narcotic analgesics. It is difficult to achieve perioperative analgesia in these patients. The dosage of narcotics can be decreased (that of trimeperidine on an average from 80 to 45 mg/day) in the early postoperative period if non-narcotic analgesics, such as paracetamol 4 g/day, are incorporated into the analgesic regimen. Paracetamol promotes pain relief to moderate and mild (not more than 40-50 VAS scores and 3-4 NRS scores), without affecting hemostasis (the thromboelastogram readings differed statistically insignificantly; the coagulation index was 0.6-1.6) and without having a hepatotoxic effect.
  
  
  CONCLUSIONS
  The systemic use of analgesics in hemophiliac patients considerably makes postoperative analgesia difficult. The use of paracetamol with trimeperidine within the first 24 hours after high-trauma surgeries in hemophiliac patients (even if they have hepatitis C) is rather effective and safe.
authors.forename: E M
authors.initials: EM
authors.lastname: Shulutko
authors.forename: O K
authors.initials: OK
authors.lastname: Levchenko
authors.forename: V M
authors.initials: VM
authors.lastname: Gorodetskiĭ
authors.forename: É G
authors.initials: ÉG
authors.lastname: Gemdzhian
authors.forename: N I
authors.initials: NI
authors.lastname: Koniashina
authors.forename: A V
authors.initials: AV
authors.lastname: Krechetova
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage / Q000009:adverse effects; D000328:Adult; D000700:Analgesics / Q000008:administration & dosage / Q000009:adverse effects; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D001777:Blood Coagulation / Q000187:drug effects*; D001780:Blood Coagulation Tests / Q000379:methods; D001847:Bone Diseases / Q000601:surgery; D016903:Drug Monitoring; D004359:Drug Therapy, Combination / Q000379:methods; D005260:Female; D006467:Hemophilia A / Q000097:blood / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000379:methods; D010147:Pain Measurement; D010149:Postoperative Pain / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D011182:Postoperative Care / Q000379:methods; D011396:Promedol / Q000008:administration & dosage / Q000009:adverse effects; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D000700:Analgesics; D000082:Acetaminophen; D011396:Promedol