DOI: https://doi.org/10.22263/2312-4156.2025.2.71
Y.E. Rozin1,2, A.V. Marochkov3, A.E. Kulagin2, A.P. Panov1
Anesthetic management and postoperative pain relief in orthopedic and traumatological surgical interventions on the lower extremities in children
1Mogilev Regional Children’s Hospital, Mogilev, Republic of Belarus
2Belarusian State Medical University, Minsk, Republic of Belarus
3Mogilev Regional Clinical Hospital, Mogilev, Republic of Belarus
Vestnik VGMU. 2025;24(2):71-80.
Abstract.
Objectives. To determine the effectiveness and safety of various methods of pain relief during anesthesia for orthopedic and trauma surgical interventions on the lower extremities in children.
Material and methods. Based on the anesthesia method two groups were distinguished: the 1st of multicomponent balanced general anesthesia (n=40); the 2nd of combined anesthesia (n=50). To solve these problems, we determined: the need for inhalational anesthetics and narcotic analgesics, the depth of anesthesia, the levels of cortisol, glucose and lactate, the distribution features of local anesthetic during sciatic nerve blockades, and the duration of pain relief in the postoperative period.
Results. There were no complications associated with anesthesia. The amount of fentanyl required for pain relief during surgical interventions in patients in the 1st group was 3.7 [2.7;4.8] mcg/kg, which was 7.4 times higher than in patients in the 2nd group, where the fentanyl dosage was 0.5 [0.43;0.53] mcg/kg.
The values of the bispectral index at the traumatic stage and at the end of the operation were significantly lower in children in group 1 compared to patients in group 2 and amounted to 38 [34;45] a.u., 40 [33;44] a.u. and 48 [45;53] a.u., 50 [48;54] a.u. respectively. Reference values of cortisol, glucose and lactate did not exceed the age norm in children in both groups. In patients in the combined anesthesia group during surgery, the levels of cortisol, glucose and lactate were significantly lower than in patients in the multicomponent general anesthesia group. The duration of postoperative pain relief in group 1 was 23 [15; 65] minutes, in group 2 – 270 [240;335] minutes.
Conclusions. Both methods of pain relief are effective and safe in the anesthesia during orthopedic and traumatological surgical interventions on the lower extremities in children, however, combined anesthesia can reduce the need for narcotic analgesics and inhalational anesthetics at the traumatic stage, provide long-term pain relief and reduce the severity of the surgical stress response.
Keywords: general anesthesia, pediatric orthopedics, combined anesthesia, conduction blockades, small doses, cortisol.
Funding. The study was carried out with the financial support of the grant of the President of the Republic of Belarus for 2024.
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Submitted 06.02.2025
Accepted 14.04.2025
Information about authors:
Yury E. Rozin – aanesthesiologist-resuscitator of the anesthesiology and resuscitation department, Mogilev Regional Children’s Hospital; postgraduate of the Chair of Pediatric Anesthesiology and Resuscitation, Institute for Advanced Training and Retraining of Healthcare Personnel of the educational institution “Belarusian State Medical University”, https://orcid.org/0000-0002-8194-9028, e-mail: Этот адрес электронной почты защищён от спам-ботов. У вас должен быть включен JavaScript для просмотра.;
A.V. Marochkov – Doctor of Medical Sciences, professor, anesthesiologist-resuscitator of the anesthesiology and resuscitation department, Mogilev Regional Clinical Hospital; https://orcid.org/0000-0001-5092-8315
A.E. Kulagin – Candidate of Medical Sciences, associate professor, head of the chair of pediatric anesthesiology and resuscitation, Institute for Advanced Training and Retraining of Healthcare Personnel of the educational institution “Belarusian State Medical University”, https://orcid.org/0009-0007-6682-0879
A.P. Panov – head of the anesthesiology and resuscitation department, Mogilev Regional Children’s Hospital.
