VARIOUS TYPES OF LOCOREGIONAL ANALGESIA IN PEDIATRIC PATIENTS

Abstract

The regional blocks, as a part of multimodal analgesia, can improve pain managementin the postoperative period and reduce the rate of complications that arise when usinga single anesthesia regimen.The aim of the study – to compare the efficacy of various regional analgesia techniques.Materials and Methods. All patients were divided into two groups: Group I included31 children who underwent anterior abdominal wall surgery under general anesthesiawith the transversalis fascia plane block (TFPB); Group II comprised 32 children whounderwent anterior abdominal wall surgery under general anesthesia with the TFPB,combined with the quadratus lumborum block 4 (QLB-4) via a single injection.Results. In children of the I group, the pain intensity indicator on the visual analog scale(VAS) after one hour constituted 4.6±0.16 points, while in the children of the II group it was 3.5±0.15 (р<0.05). The assessment of pain intensity according to VAS in thedynamics of the postoperative period showed that children of group I 6 hours aftersurgery have 1.2 times higher pain indicators compared to children of group II (p<0.05),after 12 hours – by 1.7 times, after 24 hours – 1.6 times, after 36 hours – 1.5 times,and at discharge – 1.6 times (р<0.001). According to the results of the LIKERT scale,significantly higher pain indicators were established in children of group I after surgeryand at the time of discharge (10.12±0.15 and 5.45±0.22 compared to 5.93±0.19 and3.50±0 .15 in children of group II (p<0.001). The smallest volume of paracetamol usedfor pre-emptive and multimodal analgesia in children of group I was 95 ml, while inchildren of group II it was 40 ml. The largest volume, required by the children duringanalgesia was 220 mL and 150 mL in groups I and II, respectively.The mean time tocomplete the QLB-4 was 117.3±1.76 sec, while the TFPB was 121.8±3.56 sec (p =0.27).The duration of postoperative analgesia after performing the combined locoregionaltechnique was 32.56±0.5 hours, while when using the TFPB monoblock it was 22.9±0.57hours (p<0.001).Conclusions. The use of a combined block for regional analgesia during operations onthe anterior abdominal wall is accompanied by: a lower indicator of pain intensity in thepostoperative period (p<0.001); reducing the need to use «rescue doses of analgesics» inthe postoperative period (p<0.001); the spread of the sensory block at the level of T7-L2dermatomes; an increase in the duration of postoperative analgesia (p<0.001) comparedto the corresponding indicators when using the TFPB monoblock.