Postoperative anesthesia for vitreoretinal surgery in children

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Abstract


Vitreoretinal surgery for retinal detachments in children is an effective, sometimes the only method to restore vision. As practice shows, the use of minimally invasive regional techniques is increasingly used for combined anesthesia in ophthalmic surgery in children. In the postoperative period, the use of blockades can provide prolonged analgesia, thereby improving the child’s comfort level after the surgery. All types of blockades in ophthalmology have certain risks, but the pterygopalatine blockade has not any, since it is performed outside the eye structures. The research of the use of the pterygopalatine blockade after surgery in children is important not only for creating prolonged analgesia, but also for reducing vegetative reactions that can complicate the recovery period.

Purpose of the study is to increase the pain management efficacy in the postoperative period in children who have undergone extensive surgery for retinal detachment.

Materials and methods. 1st group (= 32) received postoperative analgesia — pterygopalatine blockage with ropivacaine 0.5%, 2nd group (= 28) — systemic analgesia. Changes in hemodynamics and stress index in the postoperative period were evaluated. Cortisol levels in the intensive care unit was evaluated in 2 hours later. The time and frequency use of antiemetics in the occurrence of PONV were recorded. The level of patients comfort after surgery and the pain intensity were evaluated on an integral scale and on the Verbal Rating Scale (VRS) in points.

Results. The children of 1st group did not have significant changes in heart rate and SBP in the intensive care unit. In group 1, the TI decreased by 13.2% in the intensive care unit, and in group 2, the TI increased by 28.5% after 2 hours and by 88.6% after 8 hours. 2 hours after the surgery pain was 2 points in 12.5% of the patients (1st group) and 39.2% of patients (2nd group). After 8 hours, 35.7% of patients (2nd group) reported moderate pain that required medication. There were no PONV in group 1, and it occured in 28.5% of patients in group 2. In group 1, 75% of children rated the postoperative period as comfortable, and in group 2 — 21.4% (< 0,05).

Conclusion. Pterygopalatine blockade as the main method of postoperative analgesia in the early postoperative period has got a long-term analgesic effect, reducing the frequency of nausea and vomiting, improving the quality of the postoperative period in children.


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About the authors

I. G. Oleshchenko

Irkutsk Branch of S.N. Fyodorov Eye Microsurgery Federal State Institution of Ministry of Health of the Russian Federation

Author for correspondence.
Email: iga.oleshenko@mail.ru
ORCID iD: 0000-0003-1642-5276

Russian Federation, Irkutsk

MD, PhD, anesthesiologist of department of anesthesiology

D. V. Zabolotskii

Saint-Petersburg State Pediatric Medical University of Ministry of Health of the Russian Federation

Email: iga.oleshenko@mail.ru
ORCID iD: 0000-0002-6127-0798

Russian Federation, Saint-Petersburg

T. N. Iureva

Irkutsk Branch of S.N. Fyodorov Eye Microsurgery Federal State Institution of Ministry of Health of the Russian Federation

Email: iga.oleshenko@mail.ru
ORCID iD: 0000-0003-0547-7521

Russian Federation, Irkutsk

V. A. Zaika

Irkutsk Branch of S.N. Fyodorov Eye Microsurgery Federal State Institution of Ministry of Health of the Russian Federation

Email: iga.oleshenko@mail.ru
ORCID iD: 0000-0001-9100-1751

Russian Federation, Irkutsk

V. A. Koriachkin

Saint-Petersburg State Pediatric Medical University of Ministry of Health of the Russian Federation

Email: iga.oleshenko@mail.ru
ORCID iD: 0000-0002-3400-8989

Russian Federation, Saint-Petersburg

References

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Supplementary files

Supplementary Files Action
1.
Fig. 1. Heart rate changes in groups in the postoperative period

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2.
Fig. 2. Stress index changes in groups in the postoperative period

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3.
Fig. 3. Cortisol level changes in blood in the postoperative period

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4.
Fig. 4. ROC analysis graphs (a — dependence curve of the type of anesthesia and the occurrence of  PONY, б - dependence curve of the type of anesthesia and pain level in postoperative period)

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