The role of regional anesthesia in the postoperative analgesia in pediatric patients

Abstract

Introduction/Objective Pain is a disturbing experience associated with existing or potential tissue damage, with a sensory, emotional, cognitive, and social component. The aim of this study was to show the efficiency of regional anesthetic techniques in postoperative pain in children. Methods The retrospective cohort study was conducted on a group of 564 pediatric patients during the period from 2013 to 2016. Types of regional anesthesia were classified into the following six groups: caudal, epidural, spinal block, upper limb blocks, lower limb blocks, and truncal nerve block. From statistical methods, we used descriptive statistical methods of absolute and relative numbers, measurements of variability, central tendencies for numerical features, and methods of inferential statistics. We used the ch2 test for the attributive features of observations. Results In relation to the postoperative time when an analgesic was required, a statistically significant difference was observed in the age of children (p = 0.000), disease diagnosis (p = 0.000), type of block (p = 0.000), type of local anesthetic (p = 0.000), and type of anesthesia or sedation preoperatively (p = 0.005). Conclusion Postoperative analgesia was most needed by older children and children who were awake during surgery. Children with injuries and tumors need postoperative analgesia the earliest. The longest postoperative analgesia was recorded in patients who received caudal block. The longest postoperative analgesia can be seen in patients who received levobupivacaine, bupivacaine or levobupivacaine combined with lidocaine to perform the block.

Uvod/Cilj Bol predstavlja uznemirujuće iskustvo koje je povezano sa postojećim ili mogućim oštećenjem tkiva, sa senzornom, emocionalnom, kognitivnom i socijalnom komponentom. Cilj ove studije je prikaz efikasnosti tehnika regionalne anestezije na postoperativni bol kod dece. Metode Retrospektivna kohortna studija je sprovedena na grupi od 564 pedijatrijskih bolesnika u periodu od 2013. do 2016. godine. Vrste regionalne anestezije su klasifikovane u šest grupa: kaudalna, epiduralna, spinalna, blokovi gornjih ekstremiteta, donjih ekstremiteta i blok trupa. Od statističkih metoda koristili smo deskriptivne statističke metode apsolutnih i relativnih brojeva za atributivna obeležja posmatranja, mere varijabiliteta, centralne tendencije za numerička obeležja i metode inferencijalne statistike. Izbor testova za numerička obeležja posmatranja zavisiće od raspodele podataka. Za atributivna obeležja posmatranja koristili smo ch2 test. Rezultati U odnosu na postoperativno vreme kada je bio potreban analgetik, statistički značajna razlika uočena je u uzrastu dece (p = 0,000), dijagnozi bolesti (p = 0,000), vrsti bloka (p = 0,000), vrsti korišćenog lokalnog anestetika (p = 0,000), kao i vrsti perioperativne anestezije ili sedacije (p = 0,005). Zaključak Postoperativna analgezija je najpotrebnija starijoj deci i deci koja su bila budna tokom hirurške intervencije. Najranija postoperativna analgezija je potrebna deci sa povredama i tumorima. Najduža postoperativna analgezija je zabeležena kod bolesnika koji su dobili kaudalni blok, kao i bolesnika koji su primili levobupivakain, bupivakain ili levobupivakain u kombinaciji sa bupivakainom za izvođenje bloka.