urmjУральский медицинский журналUral Medical Journal2949-4389Ural State Medical University10.52420/umj.24.4.142PSUKYYurmj-1941Research ArticleОригинальные статьи | Original articlesOriginal articlesПрименение модифицированной блокады семенного канатика у детей при операциях на паховом каналеUse of a Modified Spermatic Cord Block in Children During Inguinal Canal Surgeryhttps://orcid.org/0009-0003-1436-6484ЗаграничновЮ. А.ZagranichnovYu. A.

Заграничнов Юрий Андреевич — анестезиолог-реаниматолог отделения анестезиологии и реанимации № 1.

Екатеринбург

Yurii A. Zagranichnov — Anesthesiologist of the Department of Anesthesiology and Resuscitation No. 1, Regional Children’s Clinical Hospital.

Ekaterinburg

zagr123@mail.ruhttps://orcid.org/0000-0002-5923-4595БрезгинФ. Н.BrezginF. N.

Брезгин Фёдор Николаевич — кандидат медицинских наук, доцент кафедры анестезиологии, реаниматологии и токсикологии, институт хирургии.

Екатеринбург

Fedor N. Brezgin — Candidate of Sciences (Medicine), Associate Professor of the Department of Anesthesiology, Resuscitation, Toxicology, Institute of Surgery, Ural State Medical University.

Ekaterinburg

fedor-96@bk.ruhttps://orcid.org/0000-0001-6502-1513АстаховА. А.AstahovA. A.

Астахов Алексей Арнольдович — доктор медицинских наук, доцент, заведующий кафедрой анестезиологии и реаниматологии.

Челябинск

Aleksey A. Astahov — Doctor of Sciences (Medicine), Head of the Department of Anesthesiology and Resuscitation, South Ural State Medical University.

Chelyabinsk

alekhan@bk.ruОбластная детская клиническая больницаРоссияRegional Children’s Clinical HospitalRussian FederationУральский государственный медицинский университетРоссияUral State Medical UniversityRussian FederationЮжно-Уральский государственный медицинский университетРоссияSouth-Ural State Medical UniversityRussian Federation202527082025244142–157Copyright © Заграничнов Ю.А., Брезгин Ф.Н., Астахов А.А., 20252025Заграничнов Ю.А., Брезгин Ф.Н., Астахов А.А.Zagranichnov Y.A., Brezgin F.N., Astahov A.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.umjusmu.ru/jour/article/view/1941Введение

Введение. Применение каудальной анестезии не всегда позволяет добиться удовлетворительной блокады, а также связано с противопоказаниями, что ставит за собой цель исследования новых методов анестезии зоны пахового канала.

Цель исследования — оценка влияния блокады семенного канатика на центральную гемодинамику, сывороточный уровень кортизола; оценка интраоперационной и послеоперационной анальгезии у детей, оперированных в объеме орхидопексии по Петривальскому.

Материалы и методы

Материалы и методы. Проведено проспективное нерандомизированное исследование; включено 26 детей 1–17 лет, которым проводилась односторонняя орхидопексия по Петривальскому. Выполнялись блокады подвздошно-пахового и подвздошно-подчревного нервов, модифицированная блокада семенного канатика, инфильтрационная анестезия мошонки. Проведена оценка показателей кислотно-основного состояния, сывороточного кортизола, центральной гемодинамики (методом биоимпедансной реографии), индекса qNOX посредством монитора Conox. Оценка болевого синдрома в послеоперационном периоде произведена по шкалам FLACC, Вонга — Бейкера и визуально-аналоговой шкале в зависимости от возрастной группы.

Результаты

Результаты. Выявлено достоверное снижение уровня кортизола на момент тракции яичка (p < 0,050); по данным анализов кислотно-щелочного состояния значимых изменений не выявлено. На каждом этапе оперативного вмешательства выявлено статистически значимое снижение среднего артериального давления, ударного объема, общего периферического сосудистого сопротивления и индекса доставки кислорода на фоне применения сочетанной анестезии (p < 0,050). Показатель qNOX не повышался в ответ на болевую стимуляцию. Оценка по послеоперационным шкалам анальгезии через 1 ч. не превышала 2 [2; 4] балла у пациентов, 3 ч. — 2 [0; 4], 6 ч. — 2 [0; 3]; 12 и 24 ч. — 0 [0; 4] и 0 [0; 0] баллов соответственно.

Заключение

Заключение. Использование модифицированной блокады семенного канатика обеспечивает эффективную интраоперационную анальгезию, снижает стрессовый ответ организма на оперативное вмешательство и вызывает умеренное снижение показателей центральной гемодинамики пациентов.

Introduction

Introduction. Caudal anesthesia does not always provide satisfactory blockade and has contraindications, which sets goal of searching for new methods of inguinal canal zone blockades.

The aim of the study to assess effect of spermatic cord blockade on central hemodynamics, serum cortisol levels; to evaluate intraoperative and postoperative analgesia in children operated for orchidopexy.

Materials and methods

Materials and methods. Prospective non-randomized study was conducted, which included 26 children aged 1 to 17 years, who underwent unilateral orchidopexy. Modified spermatic cord block was performed. Acid-base balance, serum cortisol, central hemodynamic parameters using bioimpedance rheography method, qNOX index using Conox monitor were examined. Postoperative pain syndrome was assessed by FLACC, Wong-Baker, and visual analogue scale depending on age.

Results

Results. Significant decrease in cortisol levels was detected at the time of testicular traction (p < 0.050); according to acid-base balance analyses no significant changes were found. At each stage of surgical intervention statistically significant decreases were detected in mean arterial pressure, stroke volume, total peripheral vascular resistance, and oxygen delivery index (p < 0.050). qNOX index did not increase in response to pain stimulation. Score on postoperative analgesia scales did not exceed 2 [2; 4] points in patients after 1 hr., after 3 hr.— 2 [0; 4], after 6 hr.— 2 [0; 3]; after 12 and 24 hr. — 0 [0; 4] and 0 [0; 0].

Conclusion

Conclusion. Use of a modified spermatic cord block provides effective intraoperative analgesia, reduces body’s stress response to surgery and causes a moderate decrease in central hemodynamic parameters in patients.

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The authors declare that there are no conflicts of interest present.