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Введение

Для пациентов с хронической болью, у которых стандартные методы первой линии не приводят к достаточному снижению боли, интервенционная терапия может стать безопасным и эффективным вариантом. Интервенционная терапия включает группу инвазивных анальгетических методик, таких как инъекции, абляции, инфузионная терапия, нейромодуляция, а также некоторые малоинвазивные хирургические техники.

В данной статье рассматриваются наиболее распространённые интервенционные процедуры, включая противопоказания, описание самой процедуры и, при наличии, возможные осложнения. В случаях, указанных ниже, показания к процедурам и их роль в терапии при конкретных заболеваниях обсуждаются в отдельных статьях, посвященных этим заболеваниям.

Пациенты с нарушениями свертываемости крови

Пациенты с коагулопатией, принимающие антикоагулянты или антиагреганты, а также с выраженной тромбоцитопенией, могут иметь повышенный риск кровотечений при проведении интервенционных процедур. Степень риска и потенциальные последствия при возникновении кровотечения зависят от локализации вмешательства и возможности своевременно выявить и остановить кровотечение.

Решение о временной отмене антикоагулянтов и/или проведении интервенционных процедур у пациентов с тромбоцитопенией должно приниматься индивидуально. Для пациентов, принимающих антикоагулянты, необходимо провести анализ соотношения риска и пользы, учитывая причину назначения антикоагулянтной терапии. Эти решения могут потребовать согласования между интервенционистом, лечащим врачом и пациентом.

Профессиональные сообщества по лечению боли разработали рекомендации, классифицирующие уровень риска кровотечения для различных интервенционных процедур, а также предложили схемы временных интервалов между приёмом препаратов, влияющих на свёртываемость крови, и проведением процедур для минимизации риска кровотечений [1].

Процедуры на позвоночнике

Симпатические блокады и невролиз

Нейролитические процедуры

Нейромодуляция

Интратекальная терапия

Инъекции в мягкие ткани и суставы

Полезные материалы

Резюме

Список литературы