Comparison of different methods of postoperative analgesia in children with peritonitis complicated with intra-abdominal hypertension
DOI:
https://doi.org/10.15574/PS.2020.66.41Keywords:
intra-abdominal hypertension, pain, intravenous lidocaine infusion, epidural anesthesiaAbstract
Appendicular peritonitis is the most common cause of complicated intra-abdominal infection in children that leads to risk of development intra-abdominal hypertension (IAH). Post-operative pain in patients with peritonitis and IAH is associated not only with surgical trauma, but may also have somato-visceral origin. Analgesia is recommended in patients with IAH treatment to improve abdominal wall compliance. Optimal method of analgesia for patients with peritonitis and IAH has not been find out.Objective. To investigate effect of different analgesia methods on postoperative pain intensity in children with IAH after appendicular peritonitis surgery.
Materials and methods. Seventy-three children who underwent appendicular peritonitis surgery were randomized into three groups depending on the postoperative analgesia method: «Opioids» (n=25, intravenous morphine infusion), «Lidocaine» (n=22, intravenous infusion) and «EA» (n=26, epidural anesthesia). Postoperatively, evaluation of pain intensity with NRS or FLACC scale, and intra-abdominal pressure level (IAP) measurement were performed in all children. Depending on the IAP level, children were retrospectively divided into subgroups: «No IAH» (IAT˂10 mmHg) and «IAH» (IAT>10 mmHg).
Results. IAP was statistically significantly higher in children with IAH in «Opioids» group compared to «Lidocaine» (Р<0.05) and «EDA» (Р<0.05) groups. Postoperative pain intensity at rest and during movement were statistically significantly higher in «Opioids» group compared to «Lidocaine» (Р<0.01 and Р<0.001) and «EA» (Р<0.01 and Р<0.001) groups in children with IAH and without IAH. There was no statistically significant difference in the postoperative pain intensity at rest (Р>0.05) and during movements (Р>0.05) and in the morphine daily dose (Р>0.05) in children without IAH and with IAH between the «Lidocaine» and «EA» groups. Postoperative pain intensity during movements (P=0.026) and morphine daily dose (P=0.032) were statistically significantly higher in subgroup «IAH» compared to subgroup «Without IAH» in «Opioids» group. Correlation between IAP and postoperative pain intensity at rest and during movements was strong in the «Opioids» (rs=0.63; P˂0.05 and rs=0.76; P˂0.05) and «Lidocaine «(rs=0.59; P˂0.05 and rs=0.71; P˂0.05) groups and moderate during movement only in «EA» group (rs=0.43; R˂0.05) in children with IAH.
Conclusions. Pain intensity is directly proportional to intra-abdominal pressure level in children. Epidural anesthesia is optimal analgesic technique for patients with peritonitis and IAH that does not cause additional intra-abdominal pressure increase and provides sufficient somato-visceral analgesia. Intravenous lidocaine infusion can be used as alternative to epidural anesthesia.
The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institution. The informed consent of the patient was obtained for conducting the studies.
No conflict of interest was declared by the author.
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