Abstrakt
Úvod: Cieľom štúdie bolo zhodnotiť prevalenciu chronickej pooperačnej bolesti u detí tri a šesť mesiacov po operácii prednej brušnej steny a posúdiť efektivitu rôznych anestetických prístupov na jej prevenciu.
Metódy: Do štúdie bolo zaradených 60 detí (35 chlapcov a 25 dievčat) vo veku 7 - 18 rokov, ktoré boli liečené na chirurgickom oddelení a podstúpili operáciu prednej brušnej steny. Skupina I - 30 detí, ktoré boli operované v celkovej anestézii v kombinácii s blokádou fascia transversalis a blokom 4 quadratus lumborum jedinou injekciou pod sonografickou kontrolou; Skupina II - 30 detí, ktoré boli operované v celkovej anestézii s použitím opioidov. Hodnotenie akútnej bolesti a kvality zvládania bolesti sa uskutoč?ovalo pomocou vizuálnej analógovej škály (VAS), škály Face, Legs, Activity, Cry, Consolability (FLACC) a Behavioral Pain Scale. Diagnostický dotazník neuropatickej bolesti DN-4 a škála bolesti Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) boli použité na posúdenie prítomnosti chronickej alebo neuropatickej bolesti. Získané výsledky boli štatisticky spracované pomocou štatistických meraní variácie, korelačnej analýzy, Studentovho t-testu. Rozdiely sa považovali za štatisticky významné pri p < 0,05. Podiely sa štatisticky porovnávali pomocou z-testu.
Výsledky: Analýza hodnotenia akútnej bolesti u detí odhalila, že deti zo skupiny II mali počas pobytu na chirurgickom oddelení významne vyššie skóre FLACC a VAS v porovnaní so skupinou I. Prvý, druhý a tretí deň pobytu v nemocnici bola intenzita bolesti väčšia v skupine II (FLACC - 5.5 ± 0.22, 4.52 ± 0.14, 4.0 ± 0.16, VAS - 5.36 ± 0.18, 4.48 ± 0.16, 3.95 ± 0.11, resp., p < 0.05) pri v porovnaní so skupinou I (FLACC - 4.7 ± 0.17, 3.91 ± 0.28, 3.22 ± 0.22, VAS - 4.76 ± 0.28, 3.58 ± 0.28, 3.2 ± 0.36, resp. p < 0.05) 
Analýzou hodnotenia chronickej bolesti u detí (dotazník DN-4, stupnica bolesti LANSS) zistilo sa, že v skupine II bola prevalencia syndrómu chronickej bolesti väčšia (~20 %) v porovnaní so skupinou I (9 %).
Záver: Medzi výhody blokády fascia transversalis a ultrazvukom riadeného bloku quadratus lumborum prostredníctvom jedinej injekcie patrí jednoduchosť podávania, účinná peroperačná liečba bolesti, znížená potreba opioidových analgetík a nesteroidových antiflogistík v perioperačnom období a skrátená doba hospitalizácie (tab. 3, obr. 1, lit. 40).
KĽÚČOVÉ SLOVÁ: akútna pooperačná bolesť, chronická pooperačná bolesť, blok fascia transversalis, blok quadratus lumborum, manažment bolesti, prevencia.
Lek Obz 2023, 72 (10): 460-465

Myofascial nerve blocks as a method of pain management and prevention of chronic postsurgical pain in children

Abstract
The aim of the study was to evaluate the prevalence of chronic postsurgical pain in children three and six months after anterior abdominal wall surgery and to assess the use of different anesthetic approaches for its prevention.
Materials and Methods. The study included 60 (35 boys and 25 girls) children at the age of 7 - 18 years who were treated at the surgical department and underwent anterior abdominal wall surgery. Group I - 30 children who were operated on under general anesthesia using the transversalis fascia plane block, combined with the quadratus lumborum block 4 via a single injection; Group II - 30 children who were operated on under general anesthesia using opioids. The assessment of acute pain and the quality of pain management was carried out by means of the Visual Analogue Scale (VAS), the Face, Legs, Activity, Cry, Consolability (FLACC) scale, the Behavioral Pain Scale. The DN-4 neuropathic pain diagnostic questionnaire and the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) Pain Scale were used to assess the presence of chronic or neuropathic pain. The results obtained were statistically processed using statistical measures of variation, correlation analysis, Student's t-test. Differences were considered statistically significant at p < 0.05. The proportions were statistically compared by a z-test.
Results. The analysis of the acute pain assessment scores in children revealed that children of Group II, while staying in the surgical department, had significantly higher FLACC and VAS scores as compared to those in Group I. On the first, second, and third days of hospital stay, pain intensity was greater in Group II (FLACC - 5.5 ± 0.22, 4.52 ± 0.14, 4.0 ± 0.16, VAS - 5.36 ± 0.18, 4.48 ± 0.16, 3.95 ± 0.11, respectively, p < 0.05) as compared to Group I (FLACC - 4.7 ± 0.17, 3.91 ± 0.28, 3.22 ± 0.22, VAS - 4.76 ± 0.28, 3.58 ± 0.28, 3.2 ± 0.36, respectively, ? < 0.05) 
The analysis of questionnaires for chronic pain assessment in children (DN-4 questionnaire, LANSS pain scale) found that in Group II, the prevalence of chronic pain syndrome was greater (~20 %) as compared to Group I (9 %).
Conclusions. The advantages of the transversalis fascia plane block and the ultrasound-guided quadratus lumborum block via a single injection include ease of administration, effective perioperative pain management, reduced need for opioid analgesics and non-steroidal anti-inflammatory drugs perioperatively, and a shortened length of hospital stay (Tab. 3, Fig. 1, Ref. 40).
KEY WORDS: acute postsurgical pain, chronic postsurgical pain, transversal fascia plane block, quadratus lumborum block, pain management, prevention.
Lek Obz 2023, 72 (10): 460-465

CITE
SEMKOVYCH Y., DOBROVANOVO., DMYTRIIEV D.: Myofasciálne nervové blokády ako metóda manažmentu bolesti a prevencie chronických postchirurgických bolestí u detí. Lek Obz 2023, 72 (10): 460-465

Yaroslav SEMKOVYCH 1, Oleksandr DOBROVANOV 2,3, Dmytro DMYTRIIEV 4

1 Department of Anesthesiology and Intensive Care, Communal Non-Profit Enterprise "Ivano-Frankivsk Regional Children's Clinical Hospital of Ivano-Frankivsk Regional Council", Ivano-Frankivsk, Ukraine, head doc. Y. Semkovych, MD, PhD.
2 A. Getlik Clinic for Children and Adolescents of Slovak Medical University and University Hospital, Bratislava, head doc. MUDr. K. Furková, CSc. 
3 Slovak Medical University, Bratislava, head prof. MUDr. P. Šimko, CSc. 
4 National Pirogov Memorial Medical University, Vinnytsia, Ukraine, head prof. V. Petrushenko, MD., PhD.