Background Introducing the principles of multimodal analgesic therapy is necessary to provide appropriate comfort for the patient after surgery. The main objective of the study was evaluating the influence of perioperative intravenous (i.v.) lidocaine infusion on postoperative morphine requirements during the first 48 h postoperatively in children undergoing major spine surgery. Materials and methods Prospective, randomized, double-blind study: 41 children, qualified to multilevel spine surgery, were randomly divided into two treatment groups: lidocaine and placebo (control). The lidocaine group received lidocaine as a bolus of 1.5 mg/kg over 30 minutes, followed by a continuous infusion at 1 mg/kg/h to 6 hours after surgery. The protocol of perioperative management was identical for all patients. Measurements: morphine demand, intensity of postoperative pain (the Numerical Rating Scale), oral feeding initiation time, first attempts at assuming erect position, postoperative quality of life (the Acute Short-form /SF-12/ health survey). Results Patient data did not differ demographically. Compared to the control group, lidocaine treatment reduced the demand for morphine during the first 24h [95% CI 0.13 (0.11-0.28) mg/kg, p = 0.0122], 48h [95% CI 0.46 (0.22-0.52) mg/kg, p = 0.0299] after surgery and entire hospitalization [95% CI 0.58 (0.19-0.78) mg/kg, p = 0.04]; postoperative pain intensity; nutritional withdrawal period [introduction of liquid diet (p = 0.024) and solid diet (p = 0.012)], and accelerated the adoption of an upright position [sitting (p = 0.048); walking (p = 0.049)]. The SF-12 generic health survey did not differ between groups before operation, 2 months and 4 years after surgery. Conclusions Perioperative lidocaine administration, as a part of the applied analgesic therapy regimen, may decrease postoperative opioid demand and accelerates convalescence of children undergoing major surgery.

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Abstract Objectives We analyzed the influence of perioperative, intravenous (i.v.) lidocaine infusion as a part of multimodal anesthesia on concentrations of selected pain modulators. Design An observational study. Setting University Children’s Hospital in Cracow, Poland, from May 2015 to May 2018. Subjects Forty-four children undergoing extensive spinal surgery, divided into two groups after surgery: the study group (N = 23), anesthetized generally with lidocaine as a co-analgesic, and the control group (N = 22), anesthetized generally without lidocaine. Methods We assessed proinflammatory mediators like neuron growth factor (NGF), high mobility group box 1 (HMGB1), interleukin 6 (IL-6), and FOS protein before, immediately after, six hours and 12–15 hours after surgery. We evaluated pain intensity at corresponding time points using a 10-point numerical/graphical scale. Results We observed that children in the lidocaine group had reduced pain intensity in the resting state and during movement until six hours after surgery when compared with controls. We found lower NGF concentrations in the lidocaine group vs controls only at six hours after surgery. Mean HMGB1 concentrations during the postoperative period in the study group were relatively stable, whereas we observed significant increases at six hours after surgery and a slight decrease at 12–15 hours after surgery in the control group. IL-6 concentrations at six hours were lower in lidocaine patients when compared with controls. We noted a negative correlation between HMGB1, NGF, Il-6, and lidocaine concentrations after surgery. We did not find any differences in FOS protein concentrations between the groups. Conclusions Our findings suggest that intraoperative and postoperative i.v. lidocaine administration as a part of multimodal anesthesia may reduce inflammatory-dependent postoperative pain intensity.

Background: Endogenous opioids are neuropeptides involved in pain-relieving processes. In the periphery, they are synthesised and stored in cells of the immune system. Objective: In the current study, we describe the influence of perioperative, intravenous (i.v.) lidocaine infusion in children on postoperative, serum endogenous opioid concentrations in children. Methods: Forty-four children undergoing major spinal surgery were enrolled in the cohort study. They were divided into two groups: group A (n = 21) generally anesthetised with fentanyl, propofol, rocuronium, a mixture of oxygen/air/sevoflurane and with analgetics and co-analgetics: morphine, acetaminophen, metamizole, gabapentin, dexamethason and group B (n = 23) where, in addition to the above-described general anesthesia, patients were given i.v. lidocaine as a co-analgesic. We also recruited 20 healthy age- and gender-matched children (group C). We measured endogenous opioid levels in serum using immunoenzymatic methods. We evaluated postoperative pain intensity using a numerical or visual pain scale and demand for morphine. Results: The levels of measured endogenous opioids were similar in the control and in the studied groups before surgery. We noted that group B patients had lower pain intensity when compared to group A subjects. In group B, the elevated serum concentrations of β -endorphin, enkephalin and dynorphin in the postoperative period were reported. We also observed that the levels of endogenous opioids negatively correlated with morphine requirements and positively correlated with lidocaine concentration. Conclusion: Multidrug pain management including lidocaine seems to be more efficient than models without lidocaine. The endogenous opioid system should be considered as a novel target for pain relief therapy in children.

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Background: One of the most frequently performed emergency surgical procedures in children is an appendectomy. The aim of this study was to determine the benefits of supplementing standard, general anaesthesia with the ultrasound-guided right TAP block. Methods: We analyzed the medical records of 90 children of both sexes, aged 4-16 years with a body mass of 16-78 kg who underwent general anaesthesia for open appendectomy. Sixty-two individuals were anaesthetized using the standard method, while 28 patients had an additional right-sided TAP block under ultrasound guidance. Subsequently these groups were divided into 2 subgroups: children under 8 years and those older. We evaluated the total consumption of opioids, intraoperative fentanyl requirement, the amount of non-opioid analgesic and antiemetic drugs used during the whole hospitalization, time to recovery of digestive track function and length of hospital stay. Results: TAP block performed under USG guidance reduced the overall consumption of opioids (0.36 vs. 0.42 mg kg -1 , P = 0.048), significantly shortened time of fasting after the surgery (17 vs. 29 hours, P = 0.003) as well as reduced the need for antiemetic drugs: ondansetron were used only in 21.4% of children in the group with TAP block vs. 38.7% of children with standard protocol. Additionally, we noted that the application of the TAP block shortened the length of hospitalization (3 vs. 4 days, P = 0.045). Conclusion:The application of the TAP block, as a supplementary treatment to standard general anaesthesia for open appendectomy in children is a valuable component of multimodal analgesia, which might improve the quality of life of the patient and shorten the length of hospitalization.

Background: Postoperative pain is a major after-effect of surgery. Especially severe pain occurs after extensive operations on the spine. The goal of the study was to investigate the laboratory predictive factors of intense postoperative pain in children undergoing extensive surgery Methods: We recruited 41 children, median age 13 years (IQR: 10-15 years) undergoing extensive spinal surgery. The subjects were divided into two groups based on the intensity of postoperative pain measured using the 10-point numerical rating scale (NRS), visual analogue scale (VAS) or Faces Pain Scale-Revised (FPS-R). Patients with a score of 5 or higher were included in the study group while those with an NRS score of less than 5 were included in the control group. We collected detailed clinical and laboratory data before, during and after surgery. Results: The highest intensity of pain was observed in the first 6 hours after surgery. Postoperative pain was associated with a greater drop in the haemoglobin concentration and haematocrit level in the peri-operative period (P = 0.006 and P = 0.019, respectively), as well as increases in mean arterial pressure during surgery. Additionally, we found that children with intense pain had a higher total protein concentration after surgery. Conclusions: We reported that the decrease in haemoglobin and haematocrit levels, fluctuations in mean arterial pressure, as well as the total protein concentration, could be useful prognostic factors of early postoperative pain.

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