The effect of postoperative analgesia methods on gastrointestinal motility in children with peritonitis complicated with intra-abdominal hypertension

Authors

  • V.M. Perova-Sharonova Danylo Halytsky Lviv National Medical University, Lviv, Ukraine; Municipal Non-Profit Enterprise of the Lviv Regional Council “Lviv Regional Children’s Clinical Hospital “Ohmatdyt”, Lviv, Ukraine

DOI:

https://doi.org/10.22141/2224-0586.16.6.2020.216517

Keywords:

intra-abdominal hypertension, intravenous lidocaine infusion, epidural analgesia, opioid analgesia, children

Abstract

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.

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Published

2020-09-01

Issue

Section

Original Researches