GROUNDS FOR ANALGESIA TO PREVENT POSTOPERATIVE HYPERALGESIA IN CHILDREN ACCORDING TO THE MORPHOLOGICAL STUDY OF SKIN IN THE WOUND
Keywords:
analgesia, hyperalgesia, skin biopsyAbstract
The aim of our study was to determine the morphological changes in the area of skin in the wound and the development of hyperalgesia after applying various schemes of anesthesia at the early post-operating period in children with cancer. Matherials and methods. The study carried out in 47 children (13.4±2.4 years) operated for abdominal tumors (24 children, 51%), retroperitoneal tumors (23 children, 49%). Depending on the method of anesthesia, patients were divided into four groups: 1 group (12 children) — analgesia with continuous intravenous infusion of fentanyl, 2 group (12 children) — combined analgesia with bupivacaine TAP — block; 3 group (13 children) — combined spiral epidural analgesia, and 4 group (12 children) — analgesia with continuous intravenous infusion of ketamine. Results. Using high fentanyl doses (10–20 mcg/kg·hr) by continuous infusion method for analgesia in the early postoperative period in children operated on for tumors of abdominal cavity, can result into opioid-induced hyperalgesia, which is followed by skin morphological changes around the postoperative wound with the development of necrosis in its center with expressed perifocal reactive changes of severe inflammation and significant violations of microcirculation. With the formation on the 14th day of the formation of small nerve fibers. In its turn by using of TAP-block and combined spiral-epidural analgesia method small perineural edema was determined, fragmentation of nerve fibers was not determined. Using ketamine infusion results into negligible perineural edema and reduction of postoperative hyperalgesia. Conclusions. Was found that the use of high doses of fentanyl (10–20 mg/ (kgЧh)) by continuous infusion in the early postoperative period in children operated for tumors of the abdominal cavity can lead to opioids induced hyperalgesia, accompanied by morphological changes in the skin around the wound.
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