PREVENTION OF HYPERALGESIA IN CHILDREN WHEN USING VARIOUS ANESTHESIA TECHNIQUES

Abstract

Introduction. Opioid-induced hyperalgesia is characterized by a paradoxical response whereby a patient receiving opioids for pain management could actually become more sensitive to certain painful stimuli. Regional anesthesia can also impact central sensitization and reduce hyperalgesia after surgery.The objective of the study was to determine the method of preventing hyperalgesia in the early postoperative period when using different analgesic regimens in children after anterior abdominal wall surgery.Materials and Methods. The study included 87 children at the age of 7-18 years who underwent anterior abdominal wall surgery using different analgesic techniques. Group I included 33 children who underwent anterior abdominal wall surgery under general anesthesia using fentanyl. Group II comprised 27 children who underwent anterior abdominal wall surgery under general anesthesia using the transversalis fascia plane block (TFPB). Group III involved 27 children who underwent anterior abdominal wall surgery under general anesthesia using the TFPB, combined with the quadratus lumborum block 4 (QLB-4) via a single injection.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-Profit 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. Differences were considered statistically significant 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 Education Faculty, Ivano-Frankivsk National Medical University “Health Status and Adaption of Children from the Pre-Сarpathian Region with Somatic Diseases, Their Prevention” 2021-2026, state registration number 0121U111129; the author is a co-researcher.Results. In most (48.5 %) patients of Group I, the response to stimulation occurred only when applying pressure forces of 8 and 10 g, while the motor response was observed to stimulation with a pressure force of 8 g, with the FLACC scale score of 5.1±0.3, indicating insufficient pain threshold and potential development of opioid-induced hyperalgesia in the early postoperative period. In patients of Group II and Group III, the response to stimulation occurred when applying a pressure force of 8 g and the FLACC scale scores were 2.9±0.27 and 2.4±0.32, respectively (p<0.05).Conclusions. The results obtained confirmed the benefits of using regional anesthesia techniques in combination with conventional analgesia.