Experience of using multimodal opioid-saving anesthesia in children: single-center prospective randomized study

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Abstract

BACKGROUND: In the protocols of rapid recovery after surgery, it is recommended to avoid long-term administration and/ or high doses of opioids in order to reduce the severity of their adverse reactions in the postoperative period. In this regard, opioid-sparing anesthesia (OSA) may become a promising approach to the treatment of cancer patients.

AIM: To evaluate the effectiveness of multimodal OSA in the scheme “dexmedetomidine + ketamine (in subanesthetic doses) + lidocaine (intravenous infusion)” in pediatric oncosurgery.

MATERIALS AND METHODS: A single-center prospective randomized study involved 40 children aged 12 to 18 years. Patients were divided into 2 groups depending on the method of anesthesia: in group I (n =20), combined endotracheal anesthesia with opioids was performed, in group II (n =20) — multimodal OCA based on intravenous infusion of lidocaine, dexmedetomidine and subanesthetic doses of ketamine. The patients underwent extended operations in the head and neck area in the volume of thyroidectomy with fascial-sheath lymph dissection and excision of the central tissue of the neck from 2 sides.

RESULTS: With stable intraoperative hemodynamic parameters, the median total intraoperative need for analgesics in group II was: for lidocaine — 351 (289.6; 418.5) mg (which is 1.75 mg/kg per hour), for dexmedetomidine — 88.2 (38.5; 119.7) µ g, for ketamine — 21.6 (17.4; 27.3) mg. In group I, the median total intraoperative need for fentanyl was 273.7 (406; 240.9) µ g. In addition, in group I, the median amount required for postoperative analgesia of the synthetic opioid analgesic tramadol was 419 (365.6; 479) mg (which is 7.8 mg/kg; p =0.01). In group II, the median amount of lidocaine required for postoperative analgesia (1 mg/kg per hour) turned out to be 1377.3 (735.7; 1894) mg, while additional tramadol administration at a dose of 57.3 (28.5; 107.7) mg was required in only 7 (35%) patients.

CONCLUSION: Multimodal OSA based on dexmedetomidine, lidocaine, ketamine and sevoflurane is an effective and safe method of anesthesia in children from 12 to 18 years old, which is not inferior to opioid analgesics in the treatment of perioperative pain during surgical interventions on the thyroid and parathyroid glands in cancer patients, and also reduces the number of adverse reactions characteristic of opioids.

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About the authors

Anastasia A. Tsintsadze

Blokhin National Medical Research Center of Oncology; Sechenov First Moscow State Medical University (Sechenov University)

Author for correspondence.
Email: anestesia228@mail.ru
ORCID iD: 0000-0003-1897-0331
SPIN-code: 6513-9338

MD, Cand. Sci. (Medicine), anesthesiologist-resuscitator, department assistant

Russian Federation, Moscow; Moscow

Nune V. Matinyan

Blokhin National Medical Research Center of Oncology; Pirogov Russian National Research Medical University

Email: n9031990633@yandex.ru
ORCID iD: 0000-0001-7805-5616
SPIN-code: 9829-6657

MD, Dr. Sci. (Medicine), Professor

Russian Federation, Moscow; Moscow

Vladimir V. Balandin

Blokhin National Medical Research Center of Oncology

Email: vladvb18@yandex.ru
ORCID iD: 0009-0000-2587-0166
SPIN-code: 8924-5088

researcher

Russian Federation, Moscow

Ekaterina I. Belousova

Blokhin National Medical Research Center of Oncology

Email: moyra_526@mail.ru
ORCID iD: 0000-0001-9602-3052
SPIN-code: 8936-8053

MD, Cand. Sci. (Medicine), anesthesiologist-resuscitator, department assistant

Russian Federation, Moscow

Ekaterina A. Kovaleva

Blokhin National Medical Research Center of Oncology

Email: Mel_amory@mail.ru
ORCID iD: 0000-0001-9492-034X
SPIN-code: 7122-7508

MD, anesthesiologist-resuscitator

Russian Federation, Moscow

Alexey S. Slinin

National Medical Research Center of Pediatric Hematology, Oncology and Immunology named after Dmitry Rogachev

Email: eukariot03@gmail.com
ORCID iD: 0000-0002-2021-0465
SPIN-code: 4774-2930

head of the department for work with regions

Russian Federation, Moscow

Ivan A. Letyagin

Blokhin National Medical Research Center of Oncology

Email: iffan80@mail.ru
ORCID iD: 0000-0003-0137-4998
SPIN-code: 9361-1510

MD, аnesthesiologist-resuscitator

Russian Federation, Moscow

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Supplementary files

Supplementary Files
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1. JATS XML
2. Fig. 1. Dynamics of mean arterial pressure during the observation stages in the study groups. Here and in Fig. 2: РО — in the Reanimation Department.

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3. Fig. 2. Dynamics of heart rate during the observation stages in the study groups.

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4. Fig. 3. Glucose level (mmol/l) during the intraoperative period in the study groups.

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5. Fig. 4. Perioperative lactate levels (mmol/L) in study groups.

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