Department of Clinical Biochemistry, Pediatrics Institute, Jagiellonian University Medical College, Wielicka St 265, 30-663 Cracow, Poland.
Intensive Care Unit, University Children's Hospital, Wielicka St 265, 30-663 Cracow, Poland.
Curr Pharm Des. 2019;25(30):3209-3215. doi: 10.2174/1381612825666190718153209.
Endogenous opioids are neuropeptides involved in pain-relieving processes. In the periphery, they are synthesised and stored in cells of the immune system.
In the current study, we describe the influence of perioperative, intravenous (i.v.) lidocaine infusion in children on postoperative, serum endogenous opioid concentrations in children.
Forty-four children undergoing major spinal surgery were enrolled in the cohort study. They were divided into two groups: group A (n = 21) generally anesthetised with fentanyl, propofol, rocuronium, a mixture of oxygen/air/sevoflurane and with analgetics and co-analgetics: morphine, acetaminophen, metamizole, gabapentin, dexamethason and group B (n = 23) where, in addition to the above-described general anesthesia, patients were given i.v. lidocaine as a co-analgesic. We also recruited 20 healthy age- and gender-matched children (group C). We measured endogenous opioid levels in serum using immunoenzymatic methods. We evaluated postoperative pain intensity using a numerical or visual pain scale and demand for morphine.
The levels of measured endogenous opioids were similar in the control and in the studied groups before surgery. We noted that group B patients had lower pain intensity when compared to group A subjects. In group B, the elevated serum concentrations of β-endorphin, enkephalin and dynorphin in the postoperative period were reported. We also observed that the levels of endogenous opioids negatively correlated with morphine requirements and positively correlated with lidocaine concentration.
Multidrug pain management including lidocaine seems to be more efficient than models without lidocaine. The endogenous opioid system should be considered as a novel target for pain relief therapy in children.
内源性阿片肽是参与止痛过程的神经肽。在外周，它们在免疫系统的细胞中合成和储存。
在目前的研究中，我们描述了围手术期静脉内（i.v.）利多卡因输注对儿童术后血清内源性阿片肽浓度的影响。
44 名接受大脊柱手术的儿童被纳入队列研究。他们被分为两组：A 组（n = 21）通常使用芬太尼、丙泊酚、罗库溴铵、氧气/空气/七氟醚混合物以及镇痛药和辅助镇痛药（吗啡、对乙酰氨基酚、甲灭酸、加巴喷丁、地塞米松）麻醉；B 组（n = 23）除上述全身麻醉外，还给予静脉内利多卡因作为辅助镇痛药。我们还招募了 20 名年龄和性别匹配的健康儿童（C 组）。我们使用免疫酶方法测量血清中的内源性阿片肽水平。我们使用数字或视觉疼痛量表评估术后疼痛强度和对吗啡的需求。
在手术前，对照组和研究组的内源性阿片肽水平相似。我们注意到与 A 组患者相比，B 组患者的疼痛强度较低。在 B 组，报告了术后β-内啡肽、脑啡肽和强啡肽血清浓度升高。我们还观察到内源性阿片肽水平与吗啡需求呈负相关，与利多卡因浓度呈正相关。
包括利多卡因的多药物疼痛管理似乎比没有利多卡因的模型更有效。内源性阿片肽系统应被视为儿童缓解疼痛治疗的新靶点。
