THE EFFECT OF MULTIMODAL ANALGESIA ON INTRA-ABDOMINAL PRESSURE AND CLINICAL OUTCOMES IN PATIENTS WITH INTRA-ABDOMINAL HYPERTENSION SYNDROME

R. Ibadov¹, S. Ibragimov², X. Siddikov² | ¹Intensive Care Unit, Republican Specialized Scientific and Practical Medical Center of Surgery named after academician V.Vakhidov, Tashkent, Uzbekistan; ²Republican Specialized Scientific and Practical Medical Center of Surgery named after academician V.Vakhidov, Tashkent, Uzbekistan

Abstract

Background and Aims. In patients with intra-abdominal hypertension (IAH), inadequate analgesia enhances sympathetic activation, increases intra-abdominal pressure (IAP), and exacerbates organ dysfunction. The aim of the study was to assess the effectiveness of multimodal analgesia on IAP and clinical outcomes in patients with IAH.
Methods. In a prospective study of 84 patients (age 52.5±13.4 years) with grade I–III IAH, 44 received continuous epidural analgesia with 0.2% ropivacaine/fentanyl and Dexketoprofen (Dexalgin), while 40 received systemic opioid analgesia plus NSAIDs. The main causes of IAH were abdominal sepsis (34.5%), acute pancreatitis (27.4%), major abdominal surgery (23.8%), and polytrauma (14.3%). IAP, abdominal perfusion pressure (APP), pain intensity (VAS), opioid requirements, SOFA-score, duration of mechanical ventilation (MV), and ICU length of stay were assessed.
Results. In the main group after 24 hours, IAP decreased from 18.6±3.4 to 13.2±2.8 mmHg versus a decrease from 18.9±3.1 to 16.1±3.0 mmHg in the comparison group (p<0.001). APP increased to 72±9 mmHg versus 63±8 mmHg in the comparison group (p=0.002). Pain scores on the VAS were lower (3.1±1.0 vs 5.4±1.3; p<0.001), and daily opioid requirements were reduced (12.5±4.2 vs 28.7±6.5 mg morphine equivalents; p<0.001). Organ dysfunction according to the SOFA score regressed more rapidly (decrease of 3.2±1.1 points vs. 1.4±0.9; p=0.003). The duration of MV was 3.8±1.7 vs 5.6±2.4 days (p=0.01), and ICU stay was 6.5±2.3 vs 9.2±3.1 days (p=0.004).
Conclusions. In patients with IAH, multimodal analgesia significantly reduces IAP, increases APP, decreases opioid consumption, and accelerates the regression of SOFA-score. Optimized analgesia should be considered an essential component of comprehensive IAH management.