Education of an anesthesiologist in the conditions of the russian-Ukrainian war and the results of pain treatment in patients with gunshot and mine-explosive wounds during the stages of treatment in the Armed Forces of Ukraine

Abstract

Education of military anesthesiologists is critical to improving outcomes for patients with gunshot and mine-explosive wounds. After all, it is the anesthesiologist who assesses the severity of the patient’s condition, plans the tactics of intensive therapy and predicts the long-term prospects of treatment. Such components of intensive therapy include pain treatment. Ineffective analgesia or the lack of high-quality countermeasures against pain can cause its chronicity. Unfortunately, chronic pain in patients with gunshot wounds is diagnosed in 70% of cases, and in 83.3% of patients with mine-explosive wounds. That is why studying the results of the impact, stress factors of war on the patient and the education of anesthesiologists in the issues of pain treatment, on the processes of chronic pain are important and can potentially improve the results of treatment of such patients in the long term.
Methods. The results of treatment of 1166 patients with gunshot and mine-explosive wounds are presented. Pain intensity was diagnosed using a visual analog scale (VAS). The presence of acute stress reaction (ASR) was diagnosed using The hospital anxiety and depression scale (HADS) and medical history, the diagnosis was established by a psychiatrist.
Satisfaction with the results of treatment was studied using the Chaban quality of life scale (CQLS). Diagnosis of post-traumatic stress disorders (PTSD) – using the Mississippi Scale for Combat-Related PTSD (M-PTSD). Comparison of groups was carried out according to the Mann-Whitney test and the chi-square test, taking into account the correction for continuity. To analyze the relationship between the risks of receiving a negative treatment result and factor characteristics, the method
of building univariate and multivariate logistic regression models was used. The quality of the models was evaluated by the area under the ROC curve (AUC – Area under the ROC curve) To quantify the degree of influence of the factor characteristic, the odds ratio indicator was calculated.
Result. A very strong relationship between the chronicity of pain and the presence of ASR in patients, as well as CQLS data at the time of discharge from the medical institution and 1 and 3 months after treatment (AUC>0.9) was revealed. A connection with the presence of PTSD was revealed according to the M-PTSD 1 and 3 months after wounds (AUC=0.65 95% CI 0.62-0.68). Also, a high risk of chronic pain (≥95.6% of patients with chronic pain) is observed in patients with ASR at admission and HADS data >10 points, CQLS at discharge ≤75, CQLS after 1 month ≤66, CQLS after 3 months ≤66.
Conclusions. Taking into account the results of the analysis, it is clear that military anesthesiologists planning intensive care and predicting the long-term prospects of pain treatment should have the knowledge and practical skills of related specialties, because the acute stress reaction and quality of life according to the CQLS have a strong relationship with the risk of chronic pain, which requires special diagnostics.

Trial registration
ClinicalTrials.gov: Retrospectively registered on July 28,
2022 NCT05478642