<p>Hirurška inetrvencija aktivira odgovor organizma na stres, pokreću se neuroendokrine promene u organizmu, što rezultira neželjenom hemodinamskom nestabilnošću, promenama metabolizma, endokrinog i imunog sistema. Cilj ovog istraživanja je bio da se utvrdi uticaj kaudalnog bloka na nivo perioperativnog stresa i njegova efikasnot u zbrinjavanju intra- i postoperativnog bola. Ovo prospektivno, randomizirano kliničko ispitivanje obuhvatalo je 80 dečaka, uzrasta 2-5godina, kojima su bile indikovane urološke operacije. Jedna grupa (n = 38) je primila opštu anesteziju, a druga (n = 38) opštu anesteziju sa kaudalnim blokom. Mereni su intraoperativno hemodinamski parametri u 8 merenja, ukupna potrošnja svih datih lekova i intenzitet bola u 3 navrata postoperativno. Uzorci krvi uzeti su pre uvoda u anesteziju i nakon buđenja pacijenta, i ispitivan je nivo glukoze, kortizola, leukocita, leukocitarne formule, pH i laktata. Deca koja su primila kaudalni blok imala su, postoperativno, značajno niži nivo glukoze u serumu (p <0,01), koncentracije kortizola (p <0,01), leukocita i neutrofila (p <0,01), laktata i acidoze, a takođe su imali i niže ocene bola u sve tri momenta merenja (p<0,01). Intraoperativno utvrđena je veća hemodinamska stabilnost i manja potrošnja analgetika perioperativno. Takođe, u toj grupi nije bilo komplikacija. Kombinacija kaudalnog bloka sa opštom anestezijom je bezbedna metoda, koja dovodi do manjeg stresa, veće hemodinamske stabilnosti, nižih ocena bola i manje potrošnje<br />lekova.</p> / <p>Surgery generates a neuroendocrine stress response, resulting in undesirable haemodynamic instability, alterations in metabolic response and malfunctioning of the immune system. The aim of this research was to determine the effectiveness of caudal blocks in intra- and postoperative pain management and in reducing the stress response in children during the same periods. This prospective, randomized clinical trial included 80 patients scheduled for elective urological operations. One group (n = 38) received general anaesthesia and the other (n = 38) received general anaesthesia with a caudal block. Haemodynamic paramethers, drug consumption and pain intensity were measured. Blood samples for serum glucose, cortisol level, leukocytes, pH and lactate level were taken before anaesthesia induction and after awakening the patient. Children who received a caudal block had, postoperativly, significantly lower serum glucose (p < 0.01), cortisol concentrations (p < 0.01), leukocytes (p<0,01), lower lactate level and acidosis,also pain scores were lower at all 3 measurments (p<0,01). Intraoperativly greater haemodynamic stability and lower drug consumption were noticed. Also, there were no side effects or complications identified in that group. The combination of caudal block with general anaesthesia is a safe method that leads to less stress, greater haemodynamic stability, lower pain scores and lower consumption of medication.</p>
| Identifer | oai:union.ndltd.org:uns.ac.rs/oai:CRISUNS:(BISIS)113932 |
| Date | 10 July 2020 |
| Creators | Marina Pandurov |
| Contributors | Uram-Benka Anna, Drašković Biljana, Simić Dušica, Rakić Goran, Vicković Sanja, Radovanović Dragana |
| Publisher | Univerzitet u Novom Sadu, Medicinski fakultet u Novom Sadu, University of Novi Sad, Faculty of Medicine at Novi Sad |
| Source Sets | University of Novi Sad |
| Language | Serbian |
| Detected Language | Unknown |
| Type | PhD thesis |
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