Rationale for analgesia to prevent postoperative hyperalgesia in children, according to the morphological study of skin  in the wound

Dmytro Dmytriiev; Oleksandr Marchuk; Olena Kovalchuk

doi:10.31636/pmjua.v6i1.4

Authors

Dmytro Dmytriiev National Pirogov Memorial Medical University, Vinnytsia
Oleksandr Marchuk National Pirogov Memorial Medical University, Vinnytsia
Olena Kovalchuk National Pirogov Memorial Medical University, Vinnytsia

DOI:

https://doi.org/10.31636/pmjua.v6i1.4

Keywords:

analgesia, hyperalgesia, skin biopsy

Abstract

In the article, morphological changes of skin in the area of postoperative wound are displayed. It was discovered that continuous infusion of high-dose fentanyl (10–20 mcg/kg/h) for analgesia in the early postoperative period in children operated on for tumors of abdominal cavity can result into opiod-induced hyperalgesia, which is followed by skin morphological changes around the postoperative wound with the development of necrosis in it center with expressed perifocal reactive changes in the form of severe inflammation, and significant violations of microcirculation with the formation of small nerve fibers on day 14. In its turn, using TAP-block and combined spinal-epidural analgesia showed small perineural edema. The fragmentation of nerve fibers was not determined, which indicates the absence of development of postoperative hyperalgesia. Ketamine infusion results into negligible perineural edema and reduction of postoperative hyperalgesia.

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