Impact of the CD40-CD40L system on pain severity in children after anterior abdominal wall surgery using various anaesthesia techniques

Abstract

Background. The aim of the study was to assess changes in the serum CD40L level and its potential relationship with pain severity in children after anterior abdominal wall surgery on the background of general anaesthesia and its combination with various regional anaesthesia techniques. Materials and methods. The study included 87 children who underwent anterior abdominal wall surgery using different analgesic techniques. All children were divided into 3 groups: group I (n = 33) — general anaesthesia using morphine; group II (n = 27) — general anaesthesia with the transversalis fascia plane block (TFPB); group III (n = 27) — general anaesthesia using the TFPB combined with the quadratus lumborum block (QLB-4) via a single injection. Results. In group I, the mean serum level of CD40L two hours after surgery was 4,283 pg/ml, with a slight downward trend at discharge (Mann-Whitney U test = 52.5; р = 0.593). In group II, CD40L reduced significantly, by 25.3 % (U = 10.0; р = 0.002); 24 hours after surgery, it decreased by 15.1 % (U = 26.0; р = 0.20). At discharge, the level of CD40L in this group reduced significantly, by 54.4 % (U = 7.0; р = 0.003). In group III during all observation periods, the mean serum level of CD40L was 4–7.6 times lower (U = 0.0; р = 0.000) than corresponding levels in children of group II. Conclusions. The indicators of CD40L signaling were found to increase in paediatric anterior abdominal wall surgeries. There was a close positive correlation between postsurgical pain severity and CD40L serum levels. Single-injection TFPB + QLB-4 resulted in the lowest serum CD40L levels, an indicative of the lowest intensity of postsurgical pain.

Keywords

• regional analgesia
• cd40l
• postsurgical pain
• children
• pain management