BACKGROUND

Postoperative analgesia after major surgery is one of the key problems in pediatric anesthesiology.

OBJECTIVE

To evaluate the effectiveness of perioperative anesthesia and analgesia techniques in children with anorectal malformations.

MATERIAL AND METHODS

A prospective single-center randomized study involved 90 children who underwent posterior sagittal anorectoplasty by Pena. All patients were divided into three groups depending on anesthesia and analgesia technique: group I — combined anesthesia with narcotic analgesics after surgery; group II — combined anesthesia with prolonged epidural analgesia (n=30); group III — combined anesthesia with narcotic drugs in postoperative period (n=30).

RESULTS

Minimal serum cortisol after induction of anesthesia was observed in group III [7.8 (6.0—9.0) nmol/l)] that was significant compared to group I [(10.0 nmol/l); p=0.000] and group II [(10.1 nmol/l); p=0.00]. During intestinal relegation stage, the lowest serum cortisol was observed in group III (8.0 nmol/l), while the highest level was found in case of combined anesthesia (10.3 nmol/l). The most severe pain within the first hour after surgery was observed in group I (2 points), while minimum intensity was observed after caudal anesthesia (1 point). There was no pain after prolonged epidural anesthesia. Between-group differences were significant (p<0.05). Severity of pain syndrome was similar in groups I and III at discharge from the ICU, and there was no pain in group II. Maximum need for narcotic analgesics was observed in group I.

CONCLUSION

Caudal epidural anesthesia and prolonged epidural analgesia have a pronounced anti-stress effect and provide effective analgesia in early postoperative period after correction of anorectal anomalies in children.