USING A STANDARDISED APPROACH TO TREATING COMBATANT PAIN AFTER WOUNDS AT DIFFERENT LEVELS OF MEDICAL CARE IN THE ARMED FORCES OF UKRAINE

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The treatment of pain after wounds remains a challenge for doctors. According to the literature, the frequency of pain chronicity in this category of patients is 83 % on average and depends on many factors. Personalized, evidence-based standardization of pain management can reduce the percentage of chronicity. Objective. To investigate the effectiveness of using a standardized approach to the treatment of combatants' pain after wounds at different levels of medical care in the Armed Forces of Ukraine. Methods. Data on the results of treatment of 79 combatants after wounds are presented. The numerical pain scale (NPS) was used to diagnose pain intensity. Groups were compared by the Mann-Whitney test, chi-square with correction for continuity. The normality of the distribution of quantitative indicators was checked by the Shapiro-Wilk test, and the analysis of changes in indicators by the Friedman test. Results. About 80 % of combatants were in serious condition and about 17 % were in extremely serious condition when they were admitted after being wounded. In Group 1, general anaesthesia was used in 32 %, regional anaesthesia in 34 %, and regional anaesthesia with sedation in 34 %; in Group 2, general anaesthesia in 30 %, regional anaesthesia in 32 %, and regional anaesthesia with sedation in 38 %. General anaesthesia was the method of choice in 23 combatants, regional anaesthesia in 26, and regional anaesthesia with sedation in 23. At level 2, regional anaesthesia was used in 3 combatants with ASA 2 risk; 63 combatants had ASA 3 risk, where general anaesthesia was used in 10 cases, regional anaesthesia in 23 cases, and regional anaesthesia with sedation in 30 cases; 13 combatants with ASA 4 risk used general anaesthesia. After the injury (level 1), both groups had a high level of pain intensity (9 points on average), but immediately after anaesthesia, this score dropped to 4 points, which meets the criteria for sufficient pain control. Later, during treatment at levels 3 and 4, this indicator only decreased, and the frequency of pain chronicity was 21.5 %, which indicates the effectiveness of the proposed pain treatment algorithm. Conclusion. The results of our study indicate that the proposed algorithm of a standardised approach to the treatment of combatants' pain after injuries at different levels of medical care allows for high-quality pain control and reduces the frequency of chronicity.

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