REGIONAL ANESTHESIA AS A TOOL FOR PREVENTION OF CHRONIC PAIN SYNDROME IN CHILDREN AFTER ANTERIOR ABDOMINAL WALL SURGERY

Abstract

The lack of adequate assessment of childhood-onset acute pain and its proper management can result in negative consequences that continue into adulthood, including chronic pain and suffering. In pediatrics, regional anesthesia (RA) is one of the most valuable and safest means of perioperative pain management, chronic pain syndrome prevention and is an essential part of modern anesthetic practice. The aim of this study was to assess the prevalence of chronic postsurgical pain in children three and six months after anterior abdominal wall surgery and the application of various approaches to anesthesia for its prevention. Object and Research Methods. The study was conducted at a Communal Non-Profit Enterprise “Ivano-Frankivsk Regional Children’s Clinical Hospital of Ivano-Frankivsk Regional Council”. There were observed 60 (35 girls, 25 boys) children at the age of 7-18 years, who underwent treatment after anterior abdominal wall surgery at the surgicaldepartment. All children were divided into two groups: Group I comprised 30 children who underwent surgery under general anesthesia using the transversalis fascia plane block (TFPB) combined with the quadratus lumborum block (QLB) via a single intramuscular injection; Group II included 30 children who underwent surgery under general anesthesia using opioids. Results and Discussion. The prevalence of chronic pain syndrome in children of Group I and Group II was found to be 9.24±0.35% and 19.81±0.21%, respectively, with a male predominance. The analysis of the length of hospital stay in the surgical department revealed that children of Group II stayed at the hospital much longer as compared to those in Group I (3.28±0.24 days in Group II vs 2.1±0.16 days in Group I, respectively, р<0.05). In children of Group II, the indicators of scales for assessing acute pain, the FLACC and VAS scores, were significantly higher as compared to those in Group I. However, on the second and third days of hospital stay, pain intensity was higher in Group II (FLACC – 4.52±0.14 and 4.0±0.16, VAS – 4.48±0.16 and 3.95±0.11, respectively) as compared to Group I (FLACC – 3.91±0.28 and 3.22±0.22, VAS – 3.58±0.28 and 3.2±0.36, respectively). Conclusions. The use of RA techniques reduces the risk of chronic pain development in children as compared to conventional anesthesia management. The advantages of the transversalis fascia plane block combined with the quadratus lumborum block (QLB+TFPB) via a single intramuscular injection are as follows: ease of use; adequate pain control; reducing perioperative use of opioid analgesics and nonsteroidal anti-inflammatory drugs; shortening the length of hospital stay.

Keywords

• regional anesthesia,chronic pain,children.