Perova-Sharonova V. Optimization of perioperative analgesia in children with intra-abdominal hypertension in surgical pathology

The study aimed the improvement of treatment of children with intra-abdominal hypertension on the background of surgical intra-abdominal pathology by choosing the optimal method of analgesia. The prospective study included 114 patients who underwent surgery for appendicular peritonitis and were at risk of developing intra-abdominal hypertension. All children were operated under standard intravenous anesthesia (propofol, fentanyl, atracurium) with artificial lung ventilation in pressure-controlled ventilation mode. Immediately after the completion of surgical interventions children were randomized using a random number generator (https://www.random.org) into three groups depending on the method of postoperative analgesia: group "Opioids" (n=36), control group – children who received intravenous infusion of morphine 10 μg/kg/h; group "Lidocaine" (n=39) – children who received an intravenous bolus of 1,5 mg/kg and subsequent infusion of 1,5 mg/kg/h lidocaine; EDA group (epidural analgesia, n=39) – children who had epidural analgesia with 0,25% bupivacaine solution with an initial bolus of 1 mg/kg and subsequent infusion of 0,4 mg/kg/h. The study results showed that epidural analgesia and intravenous infusion of lidocaine in children with peritonitis promote faster recovery of peristalsis, reduce the time to the first stool and reduce the volume of the drainage throw the nasogastric tube, compared with systemic morphine administration (P<0,05).The study results convincingly prove that epidural analgesia is the optimal method of analgesia in children with intra-abdominal hypertension and abdominal compartment syndrome, and intravenous lidocaine infusion is a safe alternative in this group of patients with contraindications for epidural analgesia.