Myhal I. Optimization of regional methods of perioperative analgesia in children undergone pectus excavatum repair

The objects – three variants of perioperative regional anesthesia for pectus excavatum repair by Nuss; the purpose – the improvement of perioperative analgesia in children undergone pectus excavatum repair by Nuss under the combination of general anaesthesia with different regional blocks; methods – clinical assessment – evaluation of patients` physical status; computer-tomography – assessment of pectus excavatum severity by Haller index; electric-chemiluminescent method – detecting the serum cortisol level; glucose-oxidative method – detection of serum glucose level; instrumental methods – measurement of hemodynamic parameters, ventilation parameters, analysis of arterial pulse wave for estimating cardiac function; algesiometric – detecting the pain intensity with visual analoqual scale, Numeric rating scale (NRS), questionaire for identification of chronic pain, neuropatic component of chronic postoperative pain using the modified questionare PainDETECT; statistics – analyzing the results of the study; results – The study results based on the comparative analysis established adequate antinociceptive protection supplied with three variants of regional anesthesia for pectus excavatum repair by Nuss: standart epidural anaesthesia in the dermatome of maximal deformity, high epidural anaesthesia in Th2-Th3 level and bilateral paravertebral anaesthesia in the dermatome of maximal deformity. The advantage of high epidural anaesthesia as more stable hemodynamics and cardiac function intraoperatively, compared to standart epidural anaesthesia and paravertebral blockage, has been scientifically proven; The study shows for the first time that both isolated lung ventilation through the double-lumen left-side tube and ventilation through the single lumen tube provide adequate parameters of ventilation and oxygenation during pectus excavatum repair by Nuss. It is proved that isolated ventilation through a left-side double-lumen tube provides better visualization of the operating field compared to ventilation through a single-lumen tube with capnothorax; It has been shown for the first time that chronic pain after pectus excavatum repair by Nuss occurs in 32% of patients and has signs of neuropathic pain. Risk factors for the development of chronic pain have been identified: severity of deformity, intensity of acute postoperative pain and repeated surgery; The opioid-preserving effect of bilateral paravertebral anesthesia was proved for the first time in comparison with the general anesthesia and systemic analgesia for bar removal after pectus excavatum repair by Nuss; branch – Health care.