Vlasov O. Optimization of intra and postoperative analgesia in newborns by prolonged caudal block

The work is based in the research conducted of intra and postoperative analgesia in 113 newborns, which were operated due to congenital malformations and surgical infection: gastro-intestinal tract (61%), genito-urinary tract (15%), as well as diaphragm (5 %). Infectious surgical pathology, such as necrotizing ulcerative enterocolitis, peritonitis totaled 15 %. Prolonged epidural block was performed by caudal rout (63 newborns) with lidocaine and bupivacaine with brand names as anecaine and marcaine. Total intravenous anesthesia was performed in 50 newborns and opiate analgetic (morphine) was administered in postoperative period. 20 healthy newborns were examined at the age 1-10 days.The readiness criteria of newborns to anesthesia and operative treatment were determined. The contrastive dynamics of major indices of blood circulation, blood gases, acid-base reaction and water-electrolyte balance were tracked among neonates under (total) intravenous anesthesia and/or regional (epidural) anesthesia/analgesia. Bioelectric heart activity effects of local anesthetics (lidocaine, bupivacaine) were studied. It is determined that using only amide anesthetics the elongation of QRS and Q-T intervals was noticed, though this influence has mainly therapeutic rather than toxic effect. The peculiarities of postoperative analgesia by opiates and the advantage of local anesthetics for pain treatment as well as opiate influence on the duration and type of respiratory support were studied in newborns.