УДК: 615.211:616-009.7

В патофізіології болю беруть участь багато різних рецепторів, іонних каналів, які можуть слугувати мішенями для ад’ювантних препаратів. Незважаючи на появу місцевих анестетиків тривалої дії, покращення їх фармакокінетики, удосконалення техніки реґіонарного знеболювання, все це не повністю забезпечують потреби в лікуванні болю, особливо хронічного. Паралельно зі зростанням анестетичної сили місцевих анестетиків підвищується ризик їх системної токсичності. Усе це обґрунтовує застосування ад’ювантів в реґіонарній анестезії, що є цілком логічним з точки зору мультимодальної аналгезії. В статті наведений огляд сучасних літературних даних з питань застосування ад’ювантів в регіонарній анестезії. Описані механізми дії, дози, шляхи застосування ад’ювантних препаратів

Many different receptors, ion channels, are involved in the pathophysiology of pain, which can serve as targets for adjuvant drugs. Despite the advent of long-acting local anesthetics, the improvement of their pharmacokinetics, and the advanced regional anesthesia techniques, they do not fully meet the need for treatment of pain, especially chronic pain. In parallel with the increase in the anesthetic power of local anesthetics, the risk of their systemic toxicity increases. All this justifies the use of adjuvants in regional anesthesia, which is quite logical from the point of view of multimodal analgesia. In this article the authors present a review of current literature data on the use of adjuvants in regional anesthesia. The mechanisms of action, doses, and ways of administration of adjuvant drugs are described.

Background and Aims: Intraabdominal hypertension (IAH) is poorly diagnosed condition that cause splanchnic hypoperfusion
and abdominal organs ischemia and can lead to multiple organ failure. There are no scientific data regarding effect of intraabdominal pressure (IAP) on splanchnic circulation in children.
Material and Methods: Ninety‑four children after surgery for appendicular peritonitis were enrolled in the study. After IAP measurement children were included in one of two groups according IAP levels: “without IAH” (n = 51) and “with IAH” (n = 43). Superior mesenteric artery (SMA) and portal vein (PV) blood flows (BFSMA, BFPV, mL/min) were measured, and SMA and PV blood flow indexes (BFISMA, BFIPV, ml/min*m2) and abdominal perfusion pressure (APP) were calculated in both groups.
Results: Median BFISMA and BFIPV in group “with IAH” were lower by 54.38% (P ˂ 0.01) and 63.11% (P < 0.01) respectively compared to group “without IAH”. There were strong significant negative correlation between IAP and BFISMA (rs  = –0.66; P ˂ 0.0001), weak significant negative correlation between IAP and BFIPV (rs = –0.36; P = 0.0001) in group “with IAH” and weak significant negative correlation between IAP and BFISMA (rs = –0.30; P = 0.0047) in group “without IAH”. There were no statistically significant correlations between IAP and BFIPV in group “without IAH”, between BFISMA and APP in both groups and between BFIPV and APP in both groups.
Conclusion: Elevated IAP significantly reduces splanchnic blood flow in children with appendicular peritonitis. BFISMA and BFIPV negatively correlate with IAP in these patients. There is no correlation between BFISMA/BFIPV and APP in children with IAH due to appendicular peritonitis.