The use of central segmental blockades (spinal and epidural) is associated with a large number of contraindications and complications including life-threatening. The combination of general anesthesia with opioids is associated with a slow recovery of the gastrointestinal tract and other side effects of their systemic application. Therefore the search for alternative methods of pain relief in the context of Enhanced Recovery After Surgery protocols is becoming an increasingly relevant research topicn. Relative to central blocks, the fascial sheath block of peripheral nerves under ultrasound guidance is a technically simple and safe technique. This article provides a brief overview of the main blocks used for anesthesia of the anterior abdominal wall.

Anesthesiological provision of pediatric liver surgery is associated with problems related to perioperative analgesia. Standard methods of anesthesia can have contraindications and complications.The objective: To evaluate the safety and efficacy of the posterior TAP block for postoperative analgesia in pediatric liver surgery.Subjects and Methods. A prospective, single, blind, placebo-controlled pilot study was conducted. The participants were children aged 2 to 7 who underwent liver resection. The patients were divided into groups. In Control Group, combined anesthesia was performed. In Study Group, it was combined with a bilateral posterior TAP block. Pain in the postoperative period was assessed by the FLACC scale.Results. The intensity of pain in the postoperative period was higher in Control Group. More patients required tramadol administration in Control Group. There was no difference in the occurrence of the PONV syndrome. No complications associated with the block were noted.Conclusion. The posterior TAP block has a clinically significant analgesic effect and can be used for perioperative pain relief during pediatric liver surgery. This method is relatively safe. Impaired hemostasis system is not an absolute contraindication to a TAP block.

The objective: to determine severity of changes in the hemostasis system in children occurring at main stages of liver resection as well as the need for their intraoperative correction.Subjects and Methods. A single-center prospective pilot study of coagulogram and rotational thromboelastometry values was conducted in 25 children aged 0–11 years old with hepatoblastoma after a course of chemotherapy according to the PRETEX IV regimen who underwent hemihepatectomy.Results. There were no statistically significant differences in parameters of the ROTEM tests both when comparing groups and when comparing hemihepatectomy stages within the same age group of patients. At the beginning of the separation of the liver parenchyma INTEM: CT 200.00 (186.00; 238.00), CFT 88.00 (83.00; 139.00), MCF 54.00 (51.00; 61.00), ML 0.00 (0.00; 5.00) in Group I, CT 191.00 (179.00; 199.00), CFT 84.00 (79.00; 103.00), MCF 60.00 (58.00; 64.00), 4,00 (3.00; 9.00) in Group II, respectively, p > 0.05. After separation of the liver parenchyma INTEM: CT 201.00 (161.00; 237.50), CFT 93.00 (95.00; 112.00), MCF 54.00 (52.50; 59.50), ML 6.00 (2.00; 10.00) in Group I, CT 229.00 (201.00; 285.00), CFT 93.00 (78.00; 177.00), MCF 59.00 (49.00; 60.00), ML 5.00 (5.00; 10.00) in Group II, respectively, p > 0.05.Conclusion. After chemotherapy courses, children aged 0–11 years suffering from hepatoblastoma, maintain normal functional activity of the hemostasis system at all stages of surgical treatment. In children under 11 years of age, routine hemostasis correction with blood products and prothrombin complex factor concentrate is not required during the main stages of hemihepatectomy.

The objective: to assess changes of clinical and laboratory hemostasic parameters in children at the stages of orthotopic liver transplantation.Subjects and Methods. A single-centre, prospective, pilot study of coagulation test scores was performed in 20 children aged 0 to 11 years with hepatoblastoma after a course of PRETEX IV chemotherapy who underwent liver transplantation from a related donor.Results. Children from 0 to 11 years old with hepatoblastoma, after chemotherapy, retain the normal functional activity of the hemostasis system at the pre-hepatic stage of transplantation: APTT 34.6 (34.45; 38.65) s; prothrombin index (PI) 83.53 (74.09; 87.87) %; INR 1.22 (1.16; 1.42) in the 0‒2 year group, APTT 40.45 (34.9; 41, 68), PI 75.57 (64.41; 80.45) %, and INR 1.39 (1.36; 1.87) in the group aged 3‒11 years. Severe hypocoagulation develops by the end of the hepatic stage and in the first 15 minutes after the start of arterial blood flow through the graft: CT and CFT from 195.0 (189.0; 228.5) s and 163.0 (129.5; 171.5) s to 537.0 (456.0; 1,651.5) s and 468.0 (324.5; 611.5) s (p < 0.05), respectively, in the INTEM test. Hypocoagulation at this time develops due to deficiency of coagulation factors and the release of endogenous glycosaminoglycans from the endothelium transplant, as indicated by an increase in CT and CFT to 666.0 (468.5; 2,209.5) s and 254.5 (203.25; 305.75) s in INTEM, CT to 525.0 (389.0; 2028.0) s with p < 0.05 in HEPTEM in children under the age group of up to 2. Within 1 hour after the start of arterial blood flow, the effects of systemic heparinoid effects persist, which is confirmed by the dynamics of CT 360.0 (219.5; 2,116.5) s with up to 960.0 (560.5; 1,440.5) s with p < 0.05 in the EXTEM test.Conclusion. Changes in hemostasis system parameters during surgery make it possible to judge about rapidly developing coagulation and anticoagulation disorders in children of the presented age groups. Specific changes in the coagulation profile at the stages of liver transplantation in children under the age of 11 inclusive, make it possible to do without routine correction of changes in the hemostasis system.