ABSTRACT
The investigation was conducted in 20 children, operated on for abdominal oncological diseases in a 2010-2015 yrs period, using various methods of analgesia. While application of a constant infusion of high doses of phentanyl--1-4 MKr/(kg x h) in perioperative period the occurrence of the opiate-induced hyperalgesia is possible with the accompanied morphological changes in intestinal wall; in anesthesia of a transverse abdominal muscle (a TAP-blockade) and combined spinal epidural analgesia such changes were not observed.
Subject(s)
Abdominal Muscles/drug effects , Analgesia, Epidural/methods , Analgesics, Opioid/adverse effects , Fentanyl/adverse effects , Hyperalgesia/prevention & control , Abdominal Muscles/innervation , Abdominal Muscles/surgery , Abdominal Neoplasms/pathology , Abdominal Neoplasms/surgery , Adolescent , Analgesics, Opioid/administration & dosage , Child , Child, Preschool , Female , Fentanyl/administration & dosage , Humans , Hyperalgesia/etiology , Hyperalgesia/pathology , Infant , Infusions, Parenteral , Male , Pain, Postoperative/physiopathology , Pain, Postoperative/prevention & control , Postoperative Period , Retrospective StudiesABSTRACT
There were examined 47 children, operated on for tumors of abdominal cavity and retroperitoneal space. The opioid-induced hyperalgesia may occur in early postoperative period. The anesthesia conduction of m. transverses abdominis (TAP-block), using 0.375% bupivacaine solution and combined spinal epidural analgesia (CSEA) for postoperative anesthesia have promoted the hyperalgesia severity reduction. Hyperalgesia in early postoperative period was demonstrated by upgrading of the toll-like receptors (TLR-4) level in the blood. The TLR-4 expression increased in the blood was noted while application of a TAP-block and CSEA.
Subject(s)
Anesthetics, Local/therapeutic use , Bupivacaine/therapeutic use , Hyperalgesia/diagnosis , Hyperalgesia/prevention & control , Pain, Postoperative/drug therapy , Toll-Like Receptor 4/blood , Abdominal Neoplasms/pathology , Abdominal Neoplasms/surgery , Adolescent , Analgesics, Opioid/adverse effects , Anesthesia, Epidural/methods , Anesthesia, Spinal/methods , Biomarkers/blood , Child , Female , Gene Expression , Humans , Hyperalgesia/blood , Hyperalgesia/chemically induced , Male , Pain Measurement , Pain, Postoperative/blood , Pain, Postoperative/physiopathology , Postoperative Period , Retroperitoneal Neoplasms/pathology , Retroperitoneal Neoplasms/surgery , Toll-Like Receptor 4/geneticsABSTRACT
Investigations were performed in 47 children, ageing (13.4 ± 2.4) yrs at average, оperated on for abdominal tumors 24 (51%), and retroperitoneal 23 (49%). Complex investigation of the pain behavior reactions, physiological indices and laboratory stresstests have witnessed, that application of the regional anesthesia methods for postoperative anesthesia have had secured effective analgesia after traumatic operative interventions in children. In early postoperative period in children, оperated on for abdominal tumors, hyperalgesia occurrence is possible. Application of regional analgesia scheme have promoted reduction of hyperalgesia and TLR4 (Tolelike receptors) expression rate in the blood.
Subject(s)
Anesthesia, Conduction/methods , Anesthesia, General/methods , Hyperalgesia/prevention & control , Pain Measurement/methods , Pain, Postoperative/prevention & control , Adolescent , Anesthetics, Local , Biomarkers/blood , Bupivacaine , Child , Female , Fentanyl , Humans , Hyperalgesia/physiopathology , Male , Pain, Postoperative/physiopathology , Peritoneal Neoplasms/diagnosis , Peritoneal Neoplasms/pathology , Peritoneal Neoplasms/surgery , Postoperative Period , Retroperitoneal Neoplasms/diagnosis , Retroperitoneal Neoplasms/pathology , Retroperitoneal Neoplasms/surgery , Toll-Like Receptor 4/blood , Treatment OutcomeABSTRACT
Morphological changes of skin in region of operative wound were investigated. There was established, that while application of fentanyl in high doses, using constant infusion for anesthesia in early postoperative period in children, operated for abdominal cavity tumors, the opioid-induced hyperalgesia occurrence is possible, what is accompanied by morphological changes in skin around operative wound, necrosis in centre of focus, pronounced perifocal reactive changes in a kind of significant inflammation and essential disorder of microcirculation with formation of small neural fibers on the 14th day. Pronounced fibrosis of derma, formation of big quantity of collagen fibers with edema, stratification.
