The Use of Transversus Abdominis Plane Block for Analgesia Decreases the Level of Toll-Like Receptors in the Serum of Hyperalgesia Marker in the Early Postoperative Period

D.V. Dmytriiev

Abstract


In 22 children operated for tumors of abdominal cavity (average age — 14.7 ± 2.4 years), who were in the early postoperative period, we have conducted 20 measurements of mechanical pain threshold using set of 10 von Frey monofilaments (Touch-Test Sensory Evaluator, North Coast Medical Inc., CA, USA). Pain threshold was determined on the surface around the postoperative wound. The level of toll-like receptors (TLR-4) in the blood serum was determined using enzyme-linked immunosorbent assay by means of Human TLR4 ELISA Kit (NeoBiolab, CША). The use of high doses of fentanyl (10–20 μg/kg/h) for analgesia in the early postoperative period in children can lead to hyperalgesia. Hyperalgesia in the early postoperative period was detected by an increase of TLR-4 blood levels in children operated for tumors of abdominal cavity. For example, on the 3rd day of hyperalgesia, the level of TLR-4 was 14.2 ± 2.4 ng/ml, on the 5th day of hyperalgesia — 12.1 ± 1.6 ng/ml, that was significantly higher than preoperative level — 5.2 ± 1.4 ng/ml, and the use of TAP-block with 0.375% bupivacaine for postoperative analgesia results in TLR-4 expression decrease in the blood.


Keywords


hyperalgesia; toll-like receptors; postoperative period; children

References


Айзенберг В.Л., Ульрих Г.Э., Цыпин Л.Е., Заболотский Д.В. Региональная анестезия в педиатрии. — СПб.: Синтез Бук, 2012. — 304 с.

Кучин Ю.Л., Глумчер Ф.С., Бєлка К.Ю. Опіоїд-індукована гіпералгезія під час анальгоседації у пацієнтів з черепно-мозковою трамвою // Біль, знеболювання та інтенсивна терапія. — 2012. — № 1(Д). — С. 254-257.

Кучин Ю.Л. Стрес-індукована гіпералгезія у пацієнтів з множинною травмою // Біль, знеболювання та інтенсивна терапія. — 2013. — № 2(Д). — С. 262-266.

Лесной И.И. Предупреждение развития хронического послеоперационного синдрома у хирургических больных / И.И. Лесной, В.И. Черний, К.Ю. Белка // Український журнал екстремальної медицини ім. Г.О. Можаєва. — 2012. — Т. 13, № 3. — С. 26-32.

Потапов А.Л. Обезболивание после объемных открытых абдоминальных операций — опиаты или эпидуральная аналгезия? / А.Л. Потапов, Ю.Ю. Кобеляцкий // Біль, знеболювання та інтенсивна терапія. — 2011. — № 4. — С. 39-42.

Angst M.S., Clark J.D. Opioid-induced hyperalgesia // Anesthesiology. — 2006. — Vol. 104. — P. 570-87.

Wilder-Smith O.H. Arendt-Nielsen L., Postoperative hyperalgesia: its clinical importance and relevance // Anesthesiology. — 2006. — Vol. 104(3). — P. 601-7.

Lavand’homme P., De Kock M., Waterloos H. Intraoperative epidural analgesia combined with ketamine provides effective preventive analgesia in patients undergoing major digestive surgery // Anesthesiology. — 2005. — Vol. 103(4). — P. 813-20.

Lee M., Silverman S., Hansen H., Patel V., Manchikanti L. A comprehensive review of opioid-induced hyperalgesia // Pain Physician. — 2011. — Vol. 14(2). — P. 145-161.

Reine-Solange Sauer, Dagmar Hackel, Laura Morschel, Henrike Sahlbach, Ying Wang, Shaaban A Mousa, Norbert Roewer, Alexander Brack and Heike L Rittner. Toll like receptor (TLR)-4 as a regulator of peripheral endogenous opioid-mediated analgesia in inflammation // Molecular Pain. — 2014. — Vol. 10(10). — Р. 1-15.

Tong Liu, Yong-Jing Gao, Ru-Rong Ji. Emerging role of Toll-like receptors in the control of pain and itch // Neurosci Bull. — 2012. — Vol. 28(2). — Р. 131-144.

Xisheng Yan, Enshe Jiang and Han-Rong Weng. Activation of toll like receptor 4 attenuates GABA synthesis and postsynaptic GABA receptor activities in the spinal dorsal horn via releasing interleukin-1 beta // Journal of Neuroinflammation. — 2015. — Vol. 12(222). — Р. 1-14.




DOI: https://doi.org/10.22141/2224-0586.8.71.2015.79174

Refbacks

  • There are currently no refbacks.


Copyright (c) 2016 EMERGENCY MEDICINE

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

 

© Publishing House Zaslavsky, 1997-2017

 

 Яндекс.МетрикаSeo анализ сайта Рейтинг@Mail.ru