Annotation. Acute postoperative pain is still a common unresolved health-care challenge even in highly developed countries. Insufficient postoperative pain control is associated not only with patients’ sufferings but also with increased incidence of complications (cardiovascular, thromboembolic, infectious, etc.), the development of chronic postoperative pain, delayed ambulation and discharge. Perioperative anesthesia is currently one of the main concerns in abdominal surgery. According to literature data, regional analgesia methods are widely used for anesthesia in perioperative period. Transversus abdominis plane (TAP) block proved to be a reliable regional technique of postoperative multimodal analgesia for anterior abdominal wall pain. Nowadays, ultrasound-guided TAP block techniques are considered to be a gold standard in many surgeries on anterolateral abdominal wall, producing consistent analgesia and having good safety profile. However, the quality of analgesia provided by TAP blocks under ultrasound guidance is different being influenced by the approach used. The choice between the variants of TAP block technique depends on the targeted region and the duration of nerve blockage. To date, the analgesic effect of anterior lateral abdominal wall blocks during laparoscopic cholecystectomy has not been sufficiently studied. The article provides the review of the latest advances in TAP block techniques as well as its standardized nomenclature, and suggests directions for future research. The aim was to analyze and substantiate the possibility of using regional anesthesia methods of the anterior abdominal wall by implementing the TAP-block type in the perioperative period during laparoscopic cholecystectomy. We have analyzed the current information and used the PubMed database. We have also analyzed the advantages of interstitial local anesthetic (TAP block), which primarily provides better control of pain in the anterior abdominal wall, and reduces the need for opiate and non-narcotic analgesics, the prescription of which may cause several side effects. There are many methods of the TAP-block, which to some extent depend on the pain localization in the anterior abdominal wall. For laparoscopic cholecystectomy, the most anatomically and theoretically justified is the oblique subcostal Tap-block. The use of regional techniques in laparoscopic cholecystectomy, namely the TAP-block, strategically fits into the concept of the accelerated recovery ERAS protocol, one of the purposes of which serves adequate control over the post-operative pain and early recovery.

Postoperative pain control in pediatric practice is an important issue not only for patients but also for the health care system overall. The results of meta-analyses and a large number of studies have shown that intravenous infusions of lidocaine significantly improve the quality of postoperative analgesia and help reduce the consumption of narcotic analgesics after various surgical procedures in adult patients. This technique is rarely reported in the pediatric population due to insufficient data on its efficacy and safety. The purpose - to evaluate the efficacy and safety of perioperative continuous intravenous infusion of lidocaine as a component of multimodal analgesia in children aged 8 years and older to improve pain control and quick recovery after surgery. Materials and methods. The prospective controlled study included 74 (50 boys, 24 girls) children who underwent surgical procedures under general anesthesia. The age of the patients was from eight to 18 years. Patients were divided into two groups: the (study) Group 1 (n=28) included children who received intravenous lidocaine as a component of multimodal analgesia in the perioperative period, and the second (control) group (n=46) included children who were not administered lidocaine. Pain intensity, duration of the postoperative narcotic analgesics administration and their dosage, the time for recovery of intestinal motility, the transition period to full enteral nutrition, the length of hospital stay, and the nature of postoperative complications were evaluated. Data analysis was performed using the statistical package “SPSS 20” (SPSS Inc.) version 21.0.0 for Windows. Results. The results of our study demonstrated that pain intensity, as well as total postoperative morphine requirement, were significantly lower in the lidocaine group compared to the control group during the 48-hour follow-up period (p<0.05). Additional morphine analgesia on postoperative day 1 was documented in 5 (17.9%) patients in the lidocaine group and 19 (41.3%) patients in the control group. Intestinal motility was restored within 3.79±1.81 hours postoperatively in the study group and was significantly shorter compared to the control group. In the postoperative period, there was a significantly lower frequency of postoperative nausea in patients in the study group. Side effects of lidocaine infusion were not registered. Conclusions. Prolonged perioperative infusion of lidocaine as a component of multimodal analgesia helps to reduce the consumption of narcotic analgesics and significantly improves the quality of pain syndrome treatment in the postoperative period in children. Due to the earlier restoration of bowel motility, lidocaine infusion may be useful for rapid postoperative rehabilitation programs. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Surgical stress causes a wide range of functional changes in different body systems in children: nervous, cardiovascular, respiratory, and endocrine. Antinociceptive protection is the main component of anesthetic support for pediatric patients due to the immaturity of neurohumoral regulation of the central and peripheral nervous systems in childhood and, therefore, the low adaptability of the child’s organism. Purpose - to investigate stress-response markers and indicators of the functional state of the autonomic nervous system to assess the antinociceptive properties of intraoperative continuous intravenous infusion of lidocaine during surgical procedures in children. Materials and methods controlled study included 74 children (boys/girls=50/24) who underwent surgical procedures under general anesthesia. Based on the method of general anesthesia, patients were divided into two groups: the standard general anesthesia with propofol and fentanyl, (the control group - n=46) and the general anesthesia with intraoperative intravenous infusion of lidocaine (the study (lidocaine) group - n=28). The adequacy of antinociceptive protection with different methods of anesthesia during surgical, urological, and traumatological procedures in children was compared by evaluation of stress marker levels and the functional state of the autonomic nervous system. Data analysis was performed using the statistical package «SPSS 20» (SPSS Inc.) version 21.0.0 for Windows. Results. The study found that the intraoperative activation of the sympathetic tone of the autonomic nervous system along with changes in blood glucose and cortisol are less pronounced in children who received a constant infusion of lidocaine. Indicators of the functional state of the autonomic nervous system correlate with postoperative levels of stress markers. Conclusions. Prolonged perioperative infusion of lidocaine at a dose of 0.5-2 mg/kg/hour as a component of multimodal anesthesia during surgical procedures in children provides more pronounced antinociceptive protection than anesthesia with propofol in combination with fentanyl. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Annotation. The search for effective sedation schedule in management of alcohol withdrawal delirium, which would ensure both an adequate sedation level and sufficient safety profile, is an urgent problem of modern anesthesiology and intensive care medicine. In this respect, the aim of our study is to research the use of dexmedetomidine combined with magnesium preparations, which seems to be promising. The study was conducted on 80 patients with alcoholic delirium randomized into 4 groups, in which the following parameters were evaluated: delirium duration, plasma magnesium, hemodynamics parameters, presence of respiratory disorders, as well as the levels of urea, creatinine, transaminase, cortisol and serotonin in plasma. The control group patients underwent standard sedation therapy. In experimental group 1, standard sedation with benzodiazepines was supplemented magnesium sulfate. In group 2, we maintained infusion of dexmedetomidine. In group 3, we combined intravenous magnesium sulfas with dexmedetomidine infusion. Statistical processing was performed using: Mann-Whitney U-test, Wilcoxon T-test, and Kruskal-Wallace H-test. Duration of delirium proved to be significantly shorter in all study groups as compared to the controls, p <0.05. The best sedation therapy results were recorded in group 3, p <0.05. On the first day of treatment, all patients were found to have elevated MAP and heart rate, while significant improvement in hemodynamic parameters was observed on the third day, p <0.05. Cases of hypotension were detected in groups 1 and 2. On the third day of treatment, the patients of groups 2 and 3 showed significant improvement in plasma levels of cortisol and serotonin as compared to the controls, p<0.05, while serotonin level was higher in experimental group 3 as compared to the control patients, p<0.05. The use of combination of magnesium with dexmedetomidine infusion proved to be beneficial and effective in treatment of patients with alcohol withdrawal delirium improving the quality of patients’ care and shortening delirium duration.

Annotation. At present, the treatment of perioperative pain syndrome in children remains unsolved. This issue is caused not only by a stereotypical approach to the assessment of pain intensity but also due to specific pharmacotherapy of pain in pediatric patients, especially those under the age of 7 years. The purpose of this study is to investigate the effect of intravenous infusion of lidocaine on the course of the perioperative period in children under the age of 7 years. We conducted a prospective controlled study that included 76 children (45 boys, 31 girls) who underwent surgical procedures under general anesthesia. Age of the patients was from 2 months to 7 years (3.72±2.26 years). Patients were divided into two groups: the first group (n=32) included children who received intravenous lidocaine during the perioperative period, and the second (control) group (n = 44) included children who were not prescribed lidocaine. Data analysis was performed using the statistical package "SPSS 20" (SPSS Inc.) version 21.0.0 for Windows. According to the obtained data, heart rate (HR) during operative procedures and a postoperative serum cortisol level were significantly lower in the lidocaine group compared to the control group (p<0.05). The pressor response to extubation in patients of the study group was less pronounced; namely HR -109.63±14.09 bpm. to 120.75±7.61 bpm. in the control group (p<0.001), the mean arterial pressure - 70.99±8.59 mm Hg to 75.59±7.24 mm Hg, respectively (p=0.017). During the 48-hour follow-up period after surgery, pain intensity according to the FLACC pain scale was significantly lower with lidocaine administration, similarly to the average doses of narcotic analgesics used perioperatively. Perspectives for further research include a subgroup analysis of the efficacy and safety of intravenous infusion of lidocaine over the course of the perioperative period in children, depending on the type and duration of surgical procedures.