Continuous fentanyl infusion reduces intra-abdominal pressure, postoperative pain and normalizes lungs’ mechanical changes in newborn with viscera-abdominal disproportion in early post-operative period

Authors

  • Konstantin Bercun National Pirogov Memorial Medical University, Vinnytsia, Ukraine
  • Oleksandr Nazarchuk National Pirogov Memorial Medical University, Vinnytsia, Ukraine
  • Oleksandr Dobrovanov A. Getlik Clinic for Children and Adolescents of SMU and UHB, Bratislava, Slovakia
  • Denis Surkov Regional Children Hospital, Neonatal Intensive Care Unit, Dnipro, Ukraine
  • Viktor Vidiščák Slovak Medical University, Bratislava, Slovakia

DOI:

https://doi.org/10.31636/pmjua.v6i3.2

Keywords:

fentanyl, gastroshisis, lungs function, newborns, postoperative pain

Abstract

We aimed to study the influence of prolonged administration of fentanyl on postoperative pain, intra­ab­dominal pressure and mechanical lungs’ changes that may happen in neonates in early post­operative period. 30 newborns (in the period from January 2017 to May 2021) with gastroschisis were divided into two groups ac­cordingly to the method of analgesia (14 – morphine hydrochloride; 16 – prolonged infusion of fentanyl). Lungs’ mechanical characteristics, effectiveness of post­operative analgesia, abdominal wall relaxation was studied by monitoring of dynamic compliance (Cdyn), pressure and flow­volume loops, capnography. Apprising analgesia sta­tus, we measured hemodynamic, SаO2, blood level of cortizol, C­reactive protein (CRP), glucose, analyzed post­operative pain syndrome using visual analogue scales (VAS). Intra­abdominal pressure (IAP) was controlled by Cron. For statistic analysis we used Student’s t­test. In the group with morphine, thete was the increase of IAP by 11–12 cm H2O, being stable during some period of time, and also variable levels of pain according to VAS, the in­creasing of CRP from 0.8 ± 0.25 mg/dl by 5 mg/dl, cortisol by 674.4 nmol/l, and blood glucosae rate – 7.4 mmol/l. Periods with high traumatic effects and poor analgesia (morphine group) reasoned the increasing IAP, step by step dynamic compliance decreasing in 3.4 times, resistance increasing in 2.42 times and PIP rising till 22 cm H2O. Di­rect correlation between IAP increase and lungs’ mechanical changes took place. The study has demonstrated that prolonged administration of fentanyl prevented high increase of IAP, CRP, levels of glucose and cortizol and changes of VAS data, lungs’ mechanical characteristics.

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References

Jöhr M. Postoperative pain management in infants and children: new developments. Current Opinion in Anaesthesiology [Internet]. Ovid Technologies (Wolters Kluwer Health); 2000 Jun;13(3):285–9. Available from: https://doi.org/10.1097/00001503-200006000-00009

Malbrain MLNG. Abdominal pressure in the critically ill. Current Opinion in Critical Care [Internet]. Ovid Technologies (Wolters Kluwer Health); 2000 Feb;6(1):17–29. Available from: https://doi.org/10.1097/00075198-200002000-00003

Malbrain ML. The role of abdominal distention in the search for optimal peep in acute lung injury (ALI). Critical Care Medicine [Internet]. Ovid Technologies (Wolters Kluwer Health); 1999 Jan;27(Supplement):157A. Available from: https://doi.org/10.1097/00003246-199901001-00458

Clark RH, Slutsky AS, Gerstmann DR. Lung Protective Strategies of Ventilation in the Neonate: What Are They? Pediatrics [Internet]. American Academy of Pediatrics (AAP); 2000 Jan 1;105(1):112–4. Available from: https://doi.org/10.1542/peds.105.1.112

Obeid F. Increases in Intra-abdominal Pressure Affect Pulmonary Compliance. Archives of Surgery [Internet]. American Medical Association (AMA); 1995 May 1;130(5):544. Available from: https://doi.org/10.1001/archsurg.1995.01430050094016

Kokhno VN, Shmerko PS, IIu S. Impact of preemptive analgesia on postoperative pain syndrome in laparoscopic surgery. Anesteziologiia i reanimatologiia. 2009 Nov 1(6):68-70.

OVERHOLT RH. Intraperitoneal pressure. Archives of Surgery [Internet]. American Medical Association (AMA); 1931 May 1;22(5):691. Available from: https://doi.org/10.1001/archsurg.1931.01160050002001

Shaprynskyi V, Nazarchuk O, Faustova M, Mitiuk B, Dmytriiev D, Dobrovanov O, Kralinsky K, Babina Y. Some aspects of infectious complications in patients with surgical diseases. Multycentr trials. Lek. Obzor 2020;69(7–8):257–260.

Dmitriev DV, Dobrovanov AE, Kralinsky K, Babela R. Adaptive supportive ventilation in a child with coronavirus pneumonia and diabetes mellitus. Rossiyskiy Vestnik Perinatologii i Pediatrii (Russian Bulletin of Perinatology and Pediatrics) [Internet]. The National Academy of Pediatric Science and Innovation; 2020 Nov 22;65(5):66–72. Available from: https://doi.org/10.21508/1027-4065-2020-65-5-66-72

DMYTRIIEV D, DOBROVANOV O, KRALINSKY K, DMYTRIIEV K, MELNYChENKO M. A case report of successful experience of using adaptive support ventilation in the pediatric patient with viral interstitial pneumonia covid-19 positive. Lekarsky Obzor. 2021:119-23.

Lisnyy I, Zakalska O, Dmytriiev D, Dmytriiev K, Dobrovanov O. Pre-emptive analgesia with nonsteroidal anti-inflammatory drugs. Randomized, double-blind placebo-controlled study. Lek. Obzor 2021;70(5):195–202.

Kovalchuk VP, Nazarchuk OA, Burkot VM, Fomina NS, Prokopchuk ZM, Dobrovanov O. Biofilm forming activity of non-fermenting gram-negative bacteria. Wiadomości Lekarskie [Internet]. ALUNA; 2021;74(2):252–6. Available from: https://doi.org/10.36740/wlek202102114

Continuous fentanyl infusion reduces intra-abdominal  pressure, postoperative pain and normalizes lungs’  mechanical changes in newborn with viscera-abdominal  disproportion in early post-operative period

Published

2021-11-15

How to Cite

1.
Bercun K, Nazarchuk O, Dobrovanov O, Surkov D, Vidiščák V. Continuous fentanyl infusion reduces intra-abdominal pressure, postoperative pain and normalizes lungs’ mechanical changes in newborn with viscera-abdominal disproportion in early post-operative period. PMJUA [Internet]. 2021 Nov. 15 [cited 2021 Dec. 8];6(3):18-23. Available from: https://painmedicine.org.ua/index.php/pnmdcn/article/view/267

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Original article