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Abdominal block for pyloromyotomy assessed by the NIPE monitor: Do we consider visceral pain?
Author(s): ,
Huercio, I.*
Affiliations:
La Paz University Hospital, Pediatric Anesthesia and Intensive Care, Madrid, Spain
,
Moran, P.
Affiliations:
La Paz University Hospital, Pediatric Anesthesia and Intensive Care, Madrd, Spain
,
Pérez-Ferrer, A.
Affiliations:
La Paz University Hospital, Pediatric Anesthesia and Intensive Care, Madrid, Spain
Reinoso, F.
Affiliations:
La Paz University Hospital, Pediatric Anesthesia and Intensive Care, Madrid, Spain
ESRA Academy. Huercio I. Sep 13, 2017; 190837; 531
Ivan Huercio
Ivan Huercio

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Abstract
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Background and Aims:

 Assessing the level of intraoperative analgesia in children using the NIPE monitor when performing rectus sheath blocks under general anesthesia can be used to confirm the success of the technique. 

Methods:

We included 6 infant patients scheduled for pyloromyotomy. General anesthesia was induced and ultrasound-guided rectus sheath block was performed  prior surgery. HR, SpO2, AP and NIPE values were recorded. LLANTO behavioural pain scale and VAS scale for pain were also recorded in the PACU. 

Results:

NIPE median levels were 70.8+/- 13.3 during abdominal incision, 50.8 +/- 16.2 when the pylorus was manipulated and 74.7 +/- 14.9 during abdominal closure (p<0.05). Median values during pylorus manipulation were statistically lower than those for abdominal incision and abdominal closure (p<0.0001). Abdominal muscle relaxation was optimal in all cases. Patients remained haemodinamically stable and did not reach any value above 2 on a LLANTO scale with no needs for extra analgesia after surgery. The median NIPE values remained stable without reaching any level below 50 although instantaneous values dropped significantly when pylorous were manipulated. This instantaneous drop is caused by activation of the pain visceral fibers that innervate the pylorous and were not block with the abdominal regional technique

Conclusions:

As a conclusion, assessing the level of intraoperative analgesia in children when performing a regional technique can be interesting since it allows to confirm the success of the technique, decreases the administration of intraoperative opidoids, thus allowing a faster extubation, and could also correlate with good level of postoperative analgesia in the PACU. 

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