小儿腹部手术的区域镇痛方法

A. V. Barminskiy, A. N. Egorov, M. Kirov
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摘要

简介。围术期镇痛的充分性是外科护理的主要问题之一。本研究的目的是比较儿童腹部手术围术期镇痛的区域技术,并讨论其应用条件和有效性。我们使用 PubMed、Medline、Embase 和 Google Scholar 数据库进行了文献检索。Scopus和RSCI收录的英语和俄语出版物均在检索之列。在区域麻醉方法中,神经轴阻滞方法既有公认的高疗效,也有一些缺点和并发症,但仍然是最受欢迎的技术。目前,有一些替代方法可供选择,如筋膜间阻滞,其疗效可与神经轴技术媲美,安全性也很高。在这些技术中,我们可以区分直肌鞘阻滞、腹横肌平面阻滞、竖脊肌平面阻滞和其他方法。尽管疼痛治疗取得了进步,但儿科术后镇痛不足仍是一个严重问题。因此,通过使用现代区域阻滞技术进行多模式镇痛来优化儿童术后疼痛治疗非常重要。
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Methods of regional analgesia in abdominal surgery in pediatrics
Introduction. Adequacy of perioperative analgesia is one of the main issues of surgical care. Anatomo-physiological and psychological characteristics of childhood necessitate more thorough approach to this problem in pediatric anesthesiology, since ensuring optimal analgesia provides prevention of somatic perioperative complications and influences further physiological neuropsychiatric development of a child.The objective was to compare regional techniques of perioperative analgesia during abdominal interventions in children and to discuss the conditionsof their application and effectiveness.Materials and Methods. A literature search was conducted using PubMed, Medline, Embase, and Google Scholar databases. Both English – and Russian-language publications indexed in Scopus and RSCI were included in the search.Results. Among methods of regional anesthesia, neuroaxial blockade options, which have both high proven efficacy and several disadvantages and complications, remain the most popular techniques. Currently, the alternative methods are available, presented as interfascial blockades with anefficacy comparable to neuroaxial techniques and a wide safety profile. Among these techniques, we can distinguish rectus sheath block, transversus abdominis plane block, erector spinae plane block and other methods.Conclusion. Despite advances in pain management, inadequate postoperative analgesia in pediatric practice remains a serious problem. Therefore, it is important to optimize the treatment of postoperative pain in children by applying multimodal analgesia using modern regional blockades.
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