Influence of the choice of the method of perioperative analgesia on the possibility of early initiation of enteral nutrition as part of early rehabilitation in pediatric laparoscopic oncosurgery
Authors: Petina O. A. , Matinyan N. V. 
Published: January 2021

Introduction. The need to perform nutritional support for children with cancer is widely recognized. The body of a child suffering from a malignant tumor needs additional amounts of energy and plastic substrates. Patients with signs of protein-energy insufficiency are at risk of developing complications in the early postoperative period. A significant role in compliance with early rehabilitation after surgery (ERAS) protocol is played by the method of perioperative analgesia. Caudal epidural block is the most widely used regional method of analgesia in children, allowing to start earlier enteral nutrition and prevent the development of postoperative paresis of the gastrointestinal tract (GIT), thereby speeding up the recovery of patients after surgery. In this study, we evaluated the effectiveness and safety of early enteral nutrition tactics in oncology children, in the postoperative period during laparoscopic surgical interventions, in order to prevent gastrointestinal paresis in combination with early activation of patients. In the present study, we evaluated the effectiveness of the tactics of choosing perioperative analgesia from the perspective of the possibility of early initiation of enteral nutrition in children with oncopathology, in the postoperative period after laparoscopic surgical interventions, in order to prevent paresis of the gastrointestinal tract in combination with early activation of patients.Materials and methods. The study included 40 patients of the research Institute of Children's Oncology and Hematology of the Russian Ministry of health, ASA II—III, operated in 2017—2019for malignant abdominal tumors by laparoscopic method. Patients were divided into 2 groups randomly. The CB group included 23 children who were treated with caudal epidural block as a regional component of combined anesthesia (CB group, n = 23). The control group-GA included 17 children who underwent General anesthesia (group GA, n = 17).The analysis of the early postoperative period (day 1) was performed. Postoperative nutritional support was performed to prevent gastrointestinal paresis in combination with early activation of patients and consisted of early (from day 1 after surgery) enteral nutrition. We used a therapeutic mixture of Alfare® based on whey protein hydrolysate (for children under 1 year) and Peptamen® Junior based on hydrolyzed whey protein, a complete balanced dry mix (for children from 1 year to 10 years). The volume of enteral nutrition was calculated based on the number of calories per kg of body weight. We started therapeutic nutrition with volumes of 1/2-2/3 of the calculated volume and increased the volume to the required patient tolerance.Results. Enteral nutrition in children in the CB group was connected from 4.7 ± 0.5 hours. In the GA group, enteral nutrition was switched on in 10 (59 %) patients 20 hours after the end of surgery. 5 children developed gastrostasis, which required medication to stimulate the gastrointestinal tract.Conclusions. This study demonstrates that in the conditions of effective neuroaxial blockade in the perioperative period, it is possible to start enteral nutrition as early as possible, reducing to a minimum the frequency of postoperative intestinal paresis during laparoscopic surgical interventions, contributing to early and rapid recovery of patients.