Pre-emptive administration of intravenous acetaminophen with transversus abdominis plane block (tap-blocke) in the prevention of fentanil-induced hyperalgesia in pediatric oncological patient undergoing abdominal surgery

Abstract

Dmytriiev Dmytro, Nazarchuk Oleksandr. Pre-emptive administration of intravenous acetaminophen with transversus abdominis plane block (tap-blocke) in the prevention of fentanil-induced hyperalgesia in pediatric oncological patient undergoing abdominal surgery. Journal of Education, Health and Sport. 2015;5(10):98-107. ISSN 2391-8306. DOIhttp://dx.doi.org/10.5281/zenodo.32514

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© The Author (s) 2015;

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This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non commercial

use, distribution and reproduction in any medium, provided the work is properly cited.

The authors declare that there is no conflict of interests regarding the publication of this paper.

Received: 05.08.2015. Revised 05.09.2015. Accepted: 20.10.2015.

UDC: 616-089.5-053.2: 616-006

PRE-EMPTIVE ADMINISTRATION OF INTRAVENOUS ACETAMINOPHEN WITH TRANSVERSUS ABDOMINIS PLANE BLOCK (TAP-BLOCKE) IN THE PREVENTION OF FENTANIL-INDUCED HYPERALGESIA IN PEDIATRIC ONCOLOGICAL PATIENT UNDERGOING ABDOMINAL SURGERY

Dmytro Dmytriiev, Oleksandr Nazarchuk

Department of Anesthesiology and Intensive care,

Vinnytsya National Pirogov Memorial Medical University

Abstract

Background: Acetaminophen is a selective COX-2 agonist that has been shown to decrease the intensity of opioid-induced hyperalgesia (OIH) in children. We aimed to investigate the effects of preemptive administration of intravenous acitomenofen  in the prevention of high-dose fentanil-induced hyperalgesia in pediatric patients.

Methods: 45 patients of  American Society of Anesthesiologists physical status 1-3 undergoing abdominal surgery were randomly assigned to one of the following three groups. each of which received either IV acetaminophen  (an initial dose of 1.5 ml/kg for 40 min before before the induction of anesthesia) or placebo saline 40 min before the induction of anesthesia and intraoperative fentanil infusion: group LFH received a placebo and 0.05 μg/kg/min fentanil; group FH received a placebo and 0.3 μg/kg/min fentanil; and group AFH received IV preemptive administration acetaminophen  and TAP-blocke bupivacaine 0,3 mg/kg.

            Results: The mechanical hyperalgesia threshold 12 hr after surgery was significantly lower in group FH than in the other two groups. Postoperative pain intensity using visual analog scale (VAS) and cumulative volume of a patient controlled analgesia (PCA) containing morphine over 12 hr were significantly greater in group FH than in group AFH. The time to the first postoperative analgesic requirement was significantly shorter in group RH than in the other two groups. The sevoflurane requirement was significantly greater in group LFH than in the other groups. The frequency of hypotension and bradycardia was significantly higher, but shivering and postoperative nausea and vomiting were significantly lower in group AFH than in the other two groups.

Conclusions: High-doses of fentanil induced hyperalgesia, which presented a decreased mechanical hyperalgesia threshold, enhanced pain intensity, a shorter time to first postoperative analgesic requirement, and greater morphine consumption, but IV preemptive administration acetaminophen  alleviated those symptoms. IV preemptive administration acetaminophen may be an effective treatment option for preventing or attenuating OIH.

Key words: IV preemptive administration acetaminophen, Opioid-induced hyperalgesia, fentanil, TAP-blocke.