The effect of postoperative analgesia methods on gastrointestinal motility in children with peritonitis complicated with intra-abdominal hypertension
Keywords:intra-abdominal hypertension, intravenous lidocaine infusion, epidural analgesia, opioid analgesia, children
Background. The postoperative analgesia method can affect gastrointestinal motility, the level of intra-abdominal pressure (IAP) and lead to intra-abdominal hypertension (IAH). The purpose was to study the effect of different postoperative analgesia methods on gastrointestinal motility in children with appendicular peritonitis complicated with IAH. Materials and methods. One hundred and fifteen children operated for appendicular peritonitis were randomized into three groups depending on the postoperative analgesia method: opioids (n = 36, intravenous morphine infusion), lidocaine (n = 40, intravenous lidocaine infusion) and EDA (n = 39, epidural analgesia). The patients in each group were retrospectively divided into subgroups according to the IAP level and the presence of organ dysfunction: without IAH (IAP < 10 mmHg), IAH (IAP > 10 mmHg) and ACS (abdominal compartment syndrome, IAH with organ dysfunction). IAP level and motor function of the gastrointestinal tract were evaluated in postoperative period in all children. Results. The time needed to restore bowel motility and first feces were significantly shorter and the gastric residual volume was lower in all subgroups of EDA group compared to opioid (Р < 0.05) group. Also, the time to first feces was significantly shorter in IAH and ACS subgroups of EDA group compared to relevant subgroups in lidocaine group (Р < 0.05). The children in all subgroups of lidocaine group had statistically significantly earlier bowel motility restoration and lower gastric residual volume compared to those in opioid group (Р < 0.05). Episodes of IAP > 10 mmHg were registered significantly more often in opioid group than in lidocaine and EDA groups (Р < 0.05). The number of IAP episodes > 10 mmHg correlated positively with the time for motility restoration in all groups, and the strength of such correlation was most pronounced in opioid (rs = 0.78, p = 0.001, and rs = 0.76, p = 0.01) and lidocaine groups (rs = 0.58, p = 0.008, and rs = 0.95, p = 0.01), and moderate — in EDA group (rs = 0.39, p = 0.16, and rs = 0.46, p = 0.43). Conclusions. EDA is the most optimal method of postoperative analgesia for children with peritonitis and IAH. EDA accelerated restoration of gastrointestinal motility and prevents further increase in IAP. Intravenous lidocaine infusion can be used as an alternative method of postoperative analgesia in these patients. Systemic opioid analgesia has a negative effect on gastrointestinal motility.
Montravers P., Blot S., Dimopoulos G., Eckmann C., Eggimann P., Guirao X. et al. Therapeutic management of peritonitis: a comprehen-sive guide for intensivists. Intensive Care Med. 2016 Aug. 42(8). 1234-47. doi: 10.1007/s00134-016-4307-6. Epub 2016 Mar 16. PubMed PMID: 26984317.
Reintam Blaser A., Malbrain M.L.N.G., Regli A. Abdominal pressure and gastrointestinal function: an inseparable couple? Anaesthesiol. Intensive Ther. 2017. 49(2). 146-158. doi: 10.5603/AIT.a2017.0026. Epub 2017 May 17. Review. PubMed PMID: 28513822.
Kirkpatrick A.W., Roberts D.J., De Waele J., Jaeschke R., Malbrain M.L., De Keulenaer B. et al. Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. Intensive Care Med. 2013. 39(7). 1190-1206.
Reintam Blaser A., Starkopf J., Malbrain M.L. Abdominal signs and symptoms in intensive care patients. Anaesthesiol. Intensive Ther. 2015. 47(4). 379-87. doi:10.5603/AIT.a2015.0022. Epub 2015 May 14. Review. PubMed PMID: 25973664
Leppäniemi A., Kimball E.J., De Laet I., Malbrain M.L., Balogh Z.J., De Waele J.J. Management of abdominal sepsis — a paradigm shift? Anaesthesiol. Intensive Ther. 2015. 47(4). 400-8. doi: 10.5603/AIT.a2015.0026. Epub 2015 May 14. Review. PubMed PMID: 25973662
Thabet F.C., Ejike J.C. Intra-abdominal hypertension and abdominal compartment syndrome in pediatrics. A review. J. Crit. Care. 2017 Oct. 41. 275-282. doi:10.1016/j.jcrc.2017.06.004. Epub 2017 Jun 7. Review. PubMed PMID: 28614762
Barletta J.F., Asgeirsson T., Senagore A.J. Influence of intravenous opioid dose on postoperative ileus. Ann. Pharmacother. 2011 Jul. 45(7–8). 916-23. doi: 10.1345/aph.1Q041. Epub 2011 Jul 5. PubMed PMID: 21730280.
Van Noord B.A., Roffey P., Thangathurai D. Abdominal compartment syndrome following opioid-induced postoperative ileus. J. Clin. Anesth. 2013 Mar. 25(2). 146-9. doi: 10.1016/j.jclinane.2012.07.004. Epub 2013 Jan 17. PubMed PMID: 23333788.
Harvey K.P., Adair J.D., Isho M., Robinson R. Can intravenous lidocaine decrease postsurgical ileus and shorten hospital stay in elective bowel surgery? A pilot study and literature review. Am. J. Surg. 2009 Aug. 198(2). 231-6. doi: 10.1016/j.amjsurg.2008.10.015. Epub 2009 Mar 12. Review. PubMed PMID: 19285304.
Guay J., Nishimori M., Kopp S.L. Epidural Local Anesthetics Versus Opioid-Based Analgesic Regimens for Postoperative Gastrointestinal Paralysis, Vomiting, and Pain After Abdominal Surgery: A Cochrane Review. Anesth. Analg. 2016 Dec. 123(6). 1591-1602. Review. Pub-Med PMID: 27870743.
Hakobyan R.V., Mkhoyan G.G. Epidural analgesia decreases intraabdominal pressure in postoperative patients with primary intra-abdominal hypertension. Acta Clin. Belg. 2008 Mar-Apr. 63(2). 86-92. PubMed PMID: 18575048.
Onoglu R., Narin C., Kiyici A., Sarkilar G., Hacibeyoglu G., Baba F. et al. The Potential Effect of Epidural Anesthesia on Mesenteric In-jury after Supraceliac Aortic Clamping in a Rabbit Model. Ann. Vasc Surg. 2016 Jul. 34. 227-33. doi: 10.1016/j.avsg.2015.11.013. Epub 2016 Feb 21. PubMed PMID: 26902941.
Kapral S., Gollmann G., Bachmann D., Prohaska B., Likar R., Jandrasits O. et al. The effects of thoracic epidural anesthesia on in-traoperative visceral perfusion and metabolism. Anesth. Analg. 1999 Feb. 88(2). 402-6. PubMed PMID: 9972765.
Reintam Blaser A., Malbrain M.L., Starkopf J., Fruhwald S., Jakob S.M., De Waele J. et al. Gastrointestinal function in intensive care patients: terminology, definitions and management. Recommendations of the ESICM Working Group on Abdominal Problems. Intensive Care Med. 2012 Mar. 38(3). 384-94. doi: 10.1007/s00134-011-2459-y. Epub 2012 Feb 7. PubMed PMID: 22310869; PubMed Central PMCID: PMC3286505.
Pereira B.M., Pereira R.G., Wise R., Sugrue G., Zakrison T.L., Dorigatti A.E. et al. The role of point-of-care ultrasound in intra-abdominal hypertension management. Anaesthesiol. Intensive Ther. 2017. 49(5). 373-381. doi: 10.5603/AIT.a2017.0074. Epub 2017 Nov 28. PubMed PMID: 29182210.
Leslie J.B., Viscusi E.R., Pergolizzi J.V. Jr, Panchal S.J. Anesthetic Routines: The Anesthesiologist's Role in GI Recovery and Postopera-tive Ileus. AAdv. Prev. Med. 2011. 2011. 976904. doi: 10.4061/2011/976904. Epub 2010 Dec 29. PubMed PMID: 21991449; PubMed Central PMCID: PMC3168940.
Rollins K.E., Javanmard-Emamghissi H., Scott M.J., Lobo D.N. The impact of peri-operative intravenous lidocaine on postoperative out-come after elective colorectal surgery: A meta-analysis of randomised controlled trials. Eur. J. Anaesthesiol. 2020 Feb 26. doi: 10.1097/EJA.0000000000001165. [Epub ahead of print] PubMed PMID: 32141934.
Dunn L.K., Durieux M.E. Perioperative Use of Intravenous Lidocaine. Anesthesiology. 2017 Apr. 126(4). 729-737. doi: 10.1097/ALN.0000000000001527. Review. PubMed PMID: 28114177.
Cooke C., Kennedy E.D., Foo I., Nimmo S., Speake D., Paterson H.M. et al. Meta-analysis of the effect of perioperative intravenous lido-caine on return of gastrointestinal function after colorectal surgery. Tech. Coloproctol. 2019 Jan. 23(1). 15-24. doi: 10.1007/s10151-019-1927-1. Epub 2019 Feb 5. PubMed PMID: 30721376; PubMed Central PMCID: PMC6394718.
El-Deeb A., El-Morsy G.Z., Ghanem A.A.A., Elsharkawy A.A., Elmetwally A.S. The effects of intravenous lidocaine infusion on hospital stay after major abdominal pediatric surgery. A randomized double-blinded study. Egypt. J. Anaesth. 2013. 29. 225-230. DOI: 10.1016/j.egja.2013.02.005.
Shi W.Z., Miao Y.L., Yakoob M.Y., Cao J.B., Zhang H., Jiang Y.G. et al. Recovery of gastrointestinal function with thoracic epidural vs. systemic analgesia following gastrointestinal surgery. Acta Anaesthesiol. Scand. 2014 Sep. 58(8). 923-32. doi: 10.1111/aas.12375. Epub 2014 Jul 24. Review. PubMed PMID: 25060245.
Swenson B.R., Gottschalk A., Wells L.T., Rowlingson J.C., Thompson P.W., Barclay M. et al. Intravenous lidocaine is as effective as epi-dural bupivacaine in reducing ileus duration, hospital stay, and pain after open colon resection: a randomized clinical trial. Reg. Anesth. Pain. Med. 2010 Jul-Aug. 35(4). 370-6. doi: 10.1097/AAP.0b013e3181e8d5da. PubMed PMID: 20588151.
Wongyingsinn M., Baldini G., Charlebois P., Liberman S., Stein B., Carli F. Intravenous lidocaine versus thoracic epidural analgesia: a randomized controlled trial in patients undergoing laparoscopic colorectal surgery using an enhanced recovery program. Reg. Anesth. Pain Med. 2011 May-Jun. 36(3). 241-8. doi: 10.1097/AAP.0b013e31820d4362. PubMed PMID: 21519309.
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