The paper summarizes the results of experimental and clinical studies, which were devoted to determining the effectiveness of the use of various techniques of perioperative analgesia during anesthetic management of surgical interventions in pediatric oncology. The solution of the scientific problem is to use actively methods of regional anesthesia in the schemes of multimodal anesthesia, which results in the anti-inflammatory effect, the severity reduction of the post-aggressive stress reaction, the intensity of pain, the need for opioid analgesics, the reduction of disorders in the functioning of the cardiovascular, respiratory systems and prevention of the development of the abdominal compartment syndrome. The purpose of the study was to increase the effectiveness of anesthetic support in the perioperative period by studying the possibilities and improving the methods of multimodal analgesia. The study included 294 children aged 3 to 18 years who underwent surgical interventions for oncological pathology under conditions of combined general anesthesia with respiratory support. The effectiveness of anesthesia with the prolonged infusion of opioid analgesic fentanyl, intravenous anesthesia with ketamine (when used in sub-drug doses), long-term epidural analgesia with local anesthetic bupivacaine and prolonged anesthesia by means of the creation of a transverse plane block with bupivacaine have been studied. The experimental part of the study was performed on non-linear rats weighing 120-220 g, which modeled carrageenan inflammation. Both the results of the experimental and the clinical part of the study demonstrated that the leading mechanism in the development of postoperative pain syndrome was the post-traumatic reaction of inflammation, the maintenance of which caused the formation in the CNS of pathological centers of stable impulse. The components of multimodal analgesia that were studied, provided for the different anti-inflammatory, anti-stress and organoprotective effects on the body of experimental animals and cancer patients. The weakest effect among these groups was provided by fentanyl. Adding of ketamine or component of regional anesthesia with local anesthetic to fentanyl significantly reduced the severity of the inflammatory reaction, the stress response, the need for fentanyl, accelerated the recovery of tissues after surgical intervention, and reduced manifestations of stress disorders of the functioning of the cardiovascular system, the respiratory system and intraperitoneal hypertension in patients. The most potent was the anti-inflammatory, anti-stress and organoprotective effect of regional anesthetic methods, in which the severity of carrageenan inflammation was reduced significantly, the sizes of tissues damage decreased, the threshold of mechanical pain sensitivity increased, the size of the zone of increased pain sensitivity around the wound was reduced, the cortisol content in blood decreased, glucose and toll-like receptors type 4. Under the influence of regional anesthetics of bupivacaine, the index of resistance of the erythematous and renal arteries decreased, intra-abdominal pressure normalized, and abdominal perfusion pressure increased significantly. Improvement of respiratory complication and airway impedance during pulmonary ventilation were observed. It is proved that in clinical practice, as far as possible, circuits of multimodal analgesia with active use in their composition of regional analgesics methods with local anesthetics should be used as widely as possible. When choosing an analgesia method during perioperative anesthesia in patients undergoing surgical operation on tumors of the abdominal cavity, the advantage should be given to the simpler implementation of the combined TAP-block with a local anesthetic due to its high clinical efficacy and ease of execution compared with the method of epidural analgesia. Also, the method of combined anesthesia with the formation of TAP-block is more safe than analgesia with the method of epidural analgesia
