INVESTIGATION OF CCL2/MCP-1 LEVEL IN BLOOD SERUM OF SURGICAL PAEDIATRIC PATIENTS AS MARKER OF ADEQUACY OF PERIOPERATIVE PAIN MANAGEMENT

Abstract

BACKGROUND. Surgical treatment leads to the development of postoperative pain in 80% of cases. Therefore, prompt and effective pain management is among the key priorities for healthcare professionals. The aim of the study is to determine the CCL2 / MCP-1 level in the blood serum of patients in the postoperative period under different analgesic methods and to assess the relationship between the inflammatory response and the pain response using the Visual Analog Scale (VAS). Materials and methods. We studied 30 pediatric patients with acute surgical abdominal pathologies, aged 8 to 15 years for urgent surgical procedures requiring general anesthesia. The patients were divided into 3 groups according to selected methods of intraoperative anesthesia: the 1 group included 12 patients, who received standard general anesthesia, the 2 group involved 10 patients, who received general anesthesia and infiltration anesthesia of the wound with 0.5% bupivacaine, a local anesthetic, and the 3 group included 8 children, who received general anesthesia and wound infiltration with 0.5% bupivacaine plus adjuvant (dexamethasone – 4 mg). One hour before surgery and in the postoperative period (3 and 12 hours after surgery), the patients were asked to fill in a pain diary assessing the intensity of pain syndrome and its dynamic characteristics using a visual analogue scale (VAS). Investigation to the rate of inflammatory response was assessed by monocytechemoattractant protein-1 (MCP-1). RESULTS. We found out that the plasma CCL2 / MCP-1 level in the patients prior surgery averaged 17.25 ± 7.8 pg / ml; (p <0.05), the baseline plasma CCL2 / MCP-1 levels in the patients of all groups were nearly the same. In patients of the 1st group there was an increase in the level of CCL2 / MCP-1 in the blood plasma (2.3 times) 3 hours after surgery, p <0.05, and 12 hours after surgery, the level of the studied chemokine increased by 6.7 times compared with the results obtained before surgery (p <0,05). Patients in the second group had no increase in inflammatory markers after 3 hours, but after 12 hours after surgery, plasma CCL2 / MCP-1 level significantly increased in 2.2 times compared with the values of the chemokine before surgery (p <0,05). In patients of group 3, the level of CCL2 / MCP-1 in blood plasma did not change statistically at 3 hours and 12 hours after surgery, although on average it decreased quantitatively. In the preoperative period the pain intensity ranked by the VAS scale averaged 7.8 scores and almost did not differ in the all study groups, but in the postoperative period, the degree of pain intensity was quantitatively the lowest in group 3 compared with 1 and 2 study groups. CONCLUSION. The dynamics of plasma CCL2 / MCP-1 levels in the patients reflects the development of the general adaptation syndrome in response to trauma. The CCL2 / MCP-1 level is significantly influenced by the type of anesthesia. The multimodal approach to the pain management is considered as the most effective and optimal method in perioperative care of patients