In the treatment of pancreatitis, the task of anesthesia comes to the fore. What causes pain in this disease? Several reasons are obstruction of the pancreatic duct system, and parenchyma edema, gland inflammation, pseudocysts, morpho-functional changes in the nerve plexuses, etc.
Correction of the pain syndrome in pancreatitis presents certain difficulties for physicians, because the mechanisms of this pain are mixed. The tactics of anesthesia are chosen according to the factor prevailing in the development of pathogenesis.
If obstructive bile ducts are present, stenting, lithoextraction, intracellular lithotripsy, antispasmodics and analgesics for pancreatitis are used for anesthesia.
How to anesthetize the pancreas for autoimmune pancreatitis? In this case, drugs of ursodeoxycholic acid, corticosteroids, and also stenting of the duct system are effective.
For relief of pain in biliary pancreatitis, ursodeoxycholic acid preparations, antispasmodics and pancreatic enzymes in high doses are used. In chronic pancreatitis without large cysts, without obstruction and biliary pathology, the analgesic effect is achieved by neurolysis of the celiac plexus, the use of spasmolytic agents and normal doses of enzymes.
For pain of any origin, analgesics are used. In acute inflammation of the pancreas, doctors also prescribe pain medications for patients, but here they have their own subtleties. In connection with the mechanisms and causes of chronic abdominal pain, the appointment of pain medication has a number of limitations. For example, non-steroidal anti-inflammatory drugs are contraindicated in people with gastroenterological diseases. To eliminate pain in abdominal pancreatitis, a combination of gastric secretion inhibiting drugs with high doses of polyenzymatic drugs is recommended.
As is known, the dysfunction of the sphincter of Oddi and the dyskinetic disorders of the intestine plays a big role in the development of the pain syndrome in chronic pancreatitis. Therefore, the use of an antispasmodic agent in inflammation of the pancreas will be very justified. Today, the following requirements are imposed on spasmodics: convenient form of administration, high efficiency, long time of action, no serious side effects.
Since one of the components of pain is spasm of smooth muscles, then pancreatitis is always prescribed antispasmodics. To date, the best drugs in this area are myotropic antispasmodics. These drugs affect the muscle contractions, regardless of their origin.
Spasmolytics are divided into two groups: myotropic and anticholinergic. Among miotropic drugs, Dospatalin( Mebeverin) takes a special place. It has a double action: 1) has an antispastic effect and reduces the permeability of smooth muscle cells for Na +;2) blocks Ca2 + and reduces the outflow of K + from the cells, so it does not cause hypotension of the smooth muscles of the intestine and the sphincter of Oddi.
This drug has been shown to be highly effective as an analgesic in the management of pain syndrome arising from pancreatic diseases. Already after half an hour after taking the first capsule, an analgesic effect sets in, which lasts 12 hours. Duspatalin makes it possible to achieve a stable clinical remission, that is, after the cessation of taking this remedy, the effect persists for a long time. In addition, this medicine does not have systemic adverse reactions and is well tolerated by patients.
Anesthetics for acute pancreatitis
Despite the abundance of painkillers, one of the main methods of arresting pain in acute pancreatitis is the use of analgesics. The first choice drugs are salicylates( Aspirin) or Acetaminophen, aka Paracetamol. They are taken directly before meals in order to prevent pain. Preference, experts recommend giving Paracetamol, since it has minimal irritant effect on the pancreas. However, in patients with severe liver damage, only a field of preliminary consultation with the attending physician can be used. Since the agent is hepatotoxic.
Dosage of pain relievers for acute pancreatitis is selected individually. But, in any case, it is recommended that it be minimally possible.
A number of physicians practice for pain relief in patients with acute pancreatitis, tablets of pancreatin that do not have an acid-protective coating. They begin to activate in the stomach, as well as in the upper parts of the duodenum. However, they must necessarily be used with drugs blocking gastric secretion.
Anesthetizing injections and pills with pancreatitis
Specifically, they are most often used in the form of tablets:
- spasmolytic effect - Mebeverin, No-shpu. Also, getting rid of spasm will help the reception of Papaverin, Meteopazmil, Buskopana;
- also uses such painkillers for pancreatitis, like analgesics. For example, Baralgin, Acetamifene;
- of non-steroidal anti-inflammatory drugs are effective: Voltaren, Movalis, Indomethacin.
Any of these measures should be taken only after consultation with the doctor in charge.
At the stage of inpatient treatment, as well as at the stage of exacerbation of the disease, analgesic injections are prescribed, which have a stronger and more intense effect. Among the analgesics, the most popular are: Buprenorphine, Pentazocine.
Not infrequently the treatment regimen includes a variety of Novocain blockades. For injections that have an antispasmodic effect, use Euphyllin.
In the event that all the above drugs did not stop the pain, with the strongest attack, sometimes experts prescribe painkillers for pancreatitis that have a narcotic composition. These include: Promedol, Fentanyl.