MANAGEMENT OF CHRONIC POSTSURGICAL PAIN AND HYPERALGESIA IN CHILDREN AND ITS INFLUENCE ON COGNITIVE FUNCTIONING

Abstract

Introduction. Persistent postsurgical pain (PPSP) or chronic postsurgical pain (CPSP) is recognized as a relevantpostoperative complication. Inadequate pain management in the early postoperative period may contribute to the development of hyperalgesia and the use of local anesthetics in regional anesthesia can help in its treatment and prevention.The aim of the study was to study the eff ectiveness of regional analgesia techniques in preventing PPSP and hyperalgesiain children after anterior abdominal wall surgery and to assess quality of life (QoL) using the Cognitive Functioning Scale.Material and Methods. The study included 87 children at the age of 7-18 years who underwent anterior abdominal wallsurgery with diff erent anesthetic techniques. Group I included 27 children who underwent anterior abdominal wall surgery under general anesthesia using the transversalis fascia plane block (TFPB), combined with the quadratus lumborum block 4 (QLB-4). Group II comprised 33 children who underwent anterior abdominal wall surgery under general anesthesia using fentanyl. Group III consisted of 27 children who underwent anterior abdominal wall surgery under general anesthesia using the TFPB. General anesthesia included either inhalation anesthesia or propofol infusion. The control group included 30 healthy children whose cognitive functioning was assessed. All clinical and laboratory studies were conducted in accordance with the World Medical Association Declaration of Helsinki “Ethical Principles for Medical Research Involving Human Subjects”. According to the Law, prior to a subject’s participation in the study, a written informed consent form was signed by each subject (parents/adult guardians). The manuscript was approved by the Ethics Committee of the Communal Non- Profi t Enterprise “Ivano- Frankivsk Regional Children’s Clinical Hospital of Ivano-Frankivsk Regional Council”, as evidenced by an Excerpt from the Minute of the Committee Meeting No. 2 dated February 24, 2022.The results obtained were statistically processed using statistical measures of variation, correlation analysis, Student’s t-test.Diff erences were considered statistically signifi cant at p<0.05. The proportions were statistically compared by a z-test.The study is a fragment of the research project of the Department of Children Diseases of Postgraduate Medical EducationFaculty, Ivano- Frankivsk National Medical University “Health Status and Adaption of Children from the Precarpathian Regionwith Somatic Diseases, Their Prevention” (state registration number 0121U111129; 2021-2026).Results. A signifi cantly higher mechanical pain threshold was observed in children of Group I and Group III both three(226.422.2, 220.318.6, and 182.414.2 g/mm2, respectively, рІ-ІІ<0.05, рІІ-ІІІ<0.05) and six months (288.214.4, 276.414.8,and 174.216.4 g/mm2, respectively, рІ-ІІ<0.05, рІІ-ІІІ<0.05) after surgery.The surface area of hyperalgesia in children of Group I and Group III was signifi cantly smaller as compared to childrenof Group II three (68.69.4, 79.411.4, and 116.814.0 mm2, respectively, рІ-ІІ<0.05, рІІ-ІІІ<0.05) and six months (70.213.0,77.213.2, and 117.212.6 mm2, respectively, рІ-ІІ<0.05, рІІ-ІІІ<0.050) after surgery.The frequency of CPSP was higher in children of Group II (21%) as compared to children in Group I (4%) and Group III(11%). Additionally, assessing chronic pain with the DN4 questionnaire showed its signifi cantly lower level in children of Group Iand Group III as compared to Group II six months after surgery (5.46±0.42, 8.69±0.78, and 13.69±0.38 points, respectively,рІ-ІІ<0.05, рІІ-ІІІ<0.05, рІ-ІІІ<0.05). No statistically signifi cant diff erence in QoL assessment on the Cognitive Functioning Scale was observed on the 7th day following surgery; the QoL scores in all the groups were signifi cantly lower compared to the control group. Three months after surgery, QoL was signifi cantly lower in children of Group II (69.38±6.93 points) as compared to children of Group I (92.08±4.46 points, pІ-ІІ<0.001) and Group III (83.54±4.16 points, pІІ-ІІІ<0.01). Six months following surgery, the lowest QoL was diagnosed in children of Group II (72.08±6.64) as compared to those in Group І (94.17±4.36 points, p<0.001) and Group ІІІ (91.67±4.27, p<0.001).Conclusions.1. The use of general analgesia in combination with regional anesthesia techniques (TFPB or TFPB+QLB) was associatedwith a higher mechanical pain threshold and a smaller area of hyperalgesia around the postoperative wound three and six months after anterior abdominal wall surgery, compared to conventional anesthesia.2. In addition, combined use of regional (TFPB or QLB+TFPB) with general anesthesia demonstrated a lower frequencyof CPSP, a lower level of chronic pain, and a higher level of cognitive functioning in children throughout these time intervals.3. The results obtained provide a foundation for introducing these analgesia techniques (TFPB or TFPB+QLB) in pediatricpatients undergoing anterior abdominal wall surgery, with the aim of mitigating the eff ects of pain syndrome and improving their Qo L.