PLASMA CONCENTRATION OF FENTANYL WITH SUPRAADDITIVE EFFECT OF NEFOPAM IN COMBINED GENERAL ANESTHESIA IN CHILDREN

Abstract

Introduction. The issue of multimodal anesthesia in surgical interventions with the combination of opioid and non - opioid analgesics, which include nefopam, is relevant in both adults and children. Objectives. To evaluate the effectiveness of using nefopam with the control of the level of plasma fentanyl concentrations in children during surgical interventions. Material and methods. In a randomized study, 20 children (12-18 y.o.) were divided into two groups, the main group (OG) n=11 and the control group (CG) n=9, in which 100 ml of 0.9% sodium chloride solution was administered intravenously for 20 minutes after identically performed induction of anesthesia. Nefopam was added to the OG at a dose of 0.3 mg/kg, but not more than a total dose of 20 mg. Analgesia was maintained in the OG with fentanyl 3 μg/kg, in the CG - 5 μg/kg, the other drugs were identical, they were used in equivalent dosages and modes of administration. Hemodynamic parameters (HR, BP), plasma glucose, lactate, cortisol, acid - base status (BE, pH), gas exchange (РаО2, РаСО2), body temperature (T °C) and plasma concentration of fentanyl were assessed during anesthesia. Results. All parameters except fentanyl concentration had no significant differences between the groups. After the administration of the analgesic during induction, its concentration in the OG was within 1.8 ng/ml, and in the CG - 2.3 ng/ml. By the end of anesthesia in the MG, the plasma concentration of fentanyl practically did not change (2.1 ng/ml), while in the CG it reached 5.3 ng/ml, which actually exceeded the value of this stage in the MG by 40%. Conclusion. Preliminary, 20 minutes before surgery, infusion of nefopam at a dose of 0.3 mg/kg, but not more than a total dose of 20 mg, provides effective analgesia at a plasma fentanyl concentration of 2 ng/ml and reduces its total dose by 40%.