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1. KONGRES SLOVENSKEGA ZDRU ENJA ZA ZDRAVLJENJE BOLECINE SZZB IN SIMPOZIJ O KLINICNI NEVROFIZIOLOGIJI BOLECINE 9

Prof. SILVO LIPOV

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1. KONGRES SLOVENSKEGA ZDRU ENJA ZA ZDRAVLJENJE BOLECINE SZZB IN SIMPOZIJ O KLINICNI NEVROFIZIOLOGIJI BOLECINE 9

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    1. ANALGESIA IN PEDIATRIC SURGERY ( HOW TO MANAGE POSTOPERATIVE PAIN IN CHILDREN ) ANALGEZIJA PRI OPERIRANIH OTROCIH. ( LAJŠANJE POOPERATIVNE BOLECINE PRI OTROCIH ) Prof. Silvo Lipovšek, dr. med. PEDIATRIC SURGEON AND PROFESSOR OF PEDIATRIC SURGERY 1. KONGRES SLOVENSKEGA ZDRUŽENJA ZA ZDRAVLJENJE BOLECINE ( SZZB ) IN SIMPOZIJ O KLINICNI NEVROFIZIOLOGIJI BOLECINE 9. – 10. OKTOBRA 2009. Bled. SLOVENIJA.

    3. ANALGESIA IN PEDIATRIC SURGERY ( HOW TO MANAGE POSTOPERATIVE PAIN IN CHILDREN ) ANALGEZIJA PRI OPERIRANIH OTROCIH. ( LAJŠANJE POOPERATIVNE BOLECINE PRI OTROCIH ) Prof. Silvo Lipovšek, dr. med. PEDIATRIC SURGEON AND PROFESSOR OF PEDIATRIC SURGERY 1. KONGRES SLOVENSKEGA ZDRUŽENJA ZA ZDRAVLJENJE BOLECINE ( SZZB ) IN SIMPOZIJ O KLINICNI NEVROFIZIOLOGIJI BOLECINE 9. – 10. OKTOBRA 2009. Bled. SLOVENIJA.

    4. THE PACIENT HAS THE RIGHT TO PREVENTION OF SUFFERING AND PAIN RELIEF PACIENT IMA PRAVICO DO PREPRECEVANJA IN LAJŠANJA TRPLJENJA

    5. CHILDREN ARE WEAKER BY NATURE. SO, POSTOPERATIVE PAIN RELIEF IS ALSO A BASIC RIGHT OTROCI SO PO NARAVI ŠIBKEJŠI, ZATO JE LAJŠANJE POOPERATIVNE BOLECINE TEMELJNA PRAVICA

    6. PAIN IN CHILDREN HAS A CRUCIAL IMPACT ON HIS NORMAL ACTIVITIES

    7. UNFORTUNATELY POSTOPERATIVE PAIN RELIEF HAS BEEN UNDERESTIMATED FOR A LONG TIME AND STILL IS.

    8. BOLECINA PRI OTROCIH JE BOLJ ŠKODLJIVA, KOT PRI ODRASLIH

    9. POSTOPERATIVE PAIN IN CHILDREN CAUSE SUFFERING, AFFLICTION, POOR QUALITY OF LIFE, AND ALSO PROLONGED PSYCHOLOGICAL TRAUMATIC CONSEQUENCES POOPERATIVNA BOLECINA PRI OTROCIH POVZROCA TRPLJENJE, SLABO KAKOVOST ŽIVLJENJA, IN PUSTI, ( V ZACETKU NEVIDNE ) DOLGOTRAJNE PSIHOLOŠKE TRAVMATICNE POSLEDICE

    10. SCIENTIFIC RESEARCHES HAS SHOWN THAT IN THE POSTOPERATIVE PERIOD 75 % OF CHILDREN FEEL

    11. INTENSIVE RESEARCH HAS BEEN CARRIED OUT INTO PAIN IN CHILDREN IN THE LAST TWO DECADES IN THE AREA OF NEUROPHYSIOLOGY AND CLINICAL PHARMACOLOGY, LEADING TO GREATER INSIGHTS INTO THE PHARMACOKINETIC EFFECTS OF DRUGS IN TREATMENT OF PAIN IN CHILDREN ZNANJA IN RAZISKAVE V PODROCJU NEVROFIZIOLOGIJE, FARMAKODINAMIKE IN KLINICNE FARMACOLOGIJE SO IZREDNO NAPREDOVALE. UPORABA ZDRAVIL ZA LAJŠANJE BOLECINE PRI OTROCIH JE DANES VELIKO BOLJ VARNA

    13. IN THE “NEWBORN” THE INSUFFICIENT TREATMENT OF ACUTE POSTOPERATIVE PAIN CAUSE !.. LONGTERM DECREASE OF THE PAIN LEVEL.

    14. IN OLDER CHILDREN INSUFFICIENT TREATMENT OF POSTOPERATIVE PAIN E X T E N D S !.. POSTOPERATIVE CARE AND DELAYS QUICK RETURN TO NORMAL LIFE.

    15. ZATO, JE NEIZOGIBNO IN POTREBNO, DA SE CIMPREJ VSI ZDRAVNIKI ZAVEDAMO IN PREPRICAMO O ŠKODLJIVOSTI BOLECINE PRI OTROCIH, NOVOROJENCKIH IN NENODOŠENCKIH. IN TUDI O NJIHOVIH POSLEDICAH IT IS THEREFORE OF PARAMOUNT IMPORTANCE THAT ALL PHYSICIANS UNDERSTAND THE HARMFUL EFFECTS OF POSTOPERATIVE PAIN IN CHILDREN, NEONATES AND PREMATURE INFANTS, AND HIS CONSEQUENCES.

    16. BUT… IN SPITE OF THESE ADVANCEMENTS… TREATMENT OF PAIN IN CHILDREN, IS STILL… UNDERESTIMATED !..

    18. BASED ON EXTENSIVE WORLD LITERATURE AND RESEARCHES IN THIS DOMAIN, WE PRESENT OUR EXPERIENCE, FROM 2005 TO NOW , IN THE DEPARTMENT OF PEDIATRIC SURGERY AT THE GENERAL TEACHING HOSPITAL CELJE, THE FIRST CENTRE TO PERFORM THIS TECHNIQUE IN SLOVENIA

    19. PRVI PRISPEVEK V SLOVENIJI, KI JE OMENIL IN OPOZORIL POMEMBNOST LAJŠANJA POOPERATIVNE BOLECINE PRI OTROCIH JE BIL OBJAVLJEN NA IV. KONFERENCI SLOVENSKIH ZDRAVNIKOV IZ SVETA IN SLOVENIJE V NOVEM MESTU LETA 2005. TREATMENT OF PAIN IN PEDIATRIC SURGERY ZDRAVLJENJE POOPERATIVNE BOLECINE V OTROŠKI KIRURGIJI LIPOVŠEK SILVO, dr, med. V LJUBLJANI LETA 2007, SE JE PREDSTABILA PRVA RAZISKAVA NA TEM PODROCJU V SLOVENIJI EVALUATION OF A METHOD FOR TREATMENT OF POSTOPERATIVE PAIN IN PEDIATRIC SURGERY ( FIRST RESEARCH IN SLOVENIA ) OCENA METODE ZA LAJŠANJE POOPERATIVNE BOLECINE NA OTROŠKI KIRURGIJI ( PRVA RAZISKAVA V SLOVENIJI ) LIPOVŠEK SILVO, dr. med. DO SEDAJ SMO PREDSTAVILI IN OBJAVILI MNOGO PRISPEVKOV V SLOVENIJI IN TUJINI GLEDE LAJŠANJA POOPERATIVNE BOLECINE PRI OTROCIH , Z METODO INFILTRACIJE OPERATIVNE RANE Z LEVOBUPIVAKAINOM OSREDOTOCENI NA TAKO IMENOVANI OTROŠKI VISCERALNI KIRURGIJI

    20. THE METHOD APPLIED IS THE : “INFILTRATION OF THE OPERATIVE WOUND” AT THE END OF SURGERY WITH A “LONG-ACTING” LOCAL ANAESTHETIC.

    21. THE LONG-ACTING LOCAL ANAESTHETIC WE USED FOR INFILTRATION OF THE OPERATIVE WOUND IN OUR INVESTIGATION IS: LEVOBUPIVACAINE: ( CHIROCAINE TM. ) DOSE: 1-2 mg / kg.

    22. “INFILTRATION OF THE OPERATIVE WOUND” WITH A “LONG-ACTING” LOCAL ANAESTHETIC. AT THE END OF SURGERY

    23. “INFILTRATION OF THE OPERATIVE WOUND” WITH A “LONG-ACTING” LOCAL ANAESTHETIC. AT THE END OF SURGERY

    24. “INFILTRATION OF THE OPERATIVE WOUND” WITH A “LONG-ACTING” LOCAL ANAESTHETIC. AT THE END OF SURGERY

    26. PATIENTS WITH INFILTRATION OF OPERATIVE WOUND 933 ( 57,7% ) AGES: 1 m – 16 y WEIGHT: 4 kg – 62 kg PATIENTS WITHOUT INFILTRATION OF OPERATIVE WOUND 685 ( 42,3 % ) AGES: 1 m – 17 y WEIGHT: 5kg – 68 kg

    27. COMPARISON

    28. STANDARD VISUAL SCORE WAS USED FOR EVALUATION OF POSTOPERATIVE PAIN. EVALUATION OF POSTOPERATIVE PAIN WAS REPORTED BY: CHILD, PARENTS, NURSES and SURGEONS.

    29. COMPLICATIONS. NO CARDIAC or RESPIRATORY COMPLICATIONS. NO WOUND BLEEDING. NO WOUND INFECTION. NO WOUND LEAKING. NO WOUND DEHISCENCE. NO WOUND NECROSIS. NO NERVES INJURY. NO VASCULAR INJURY. NO MAJOR or MINOR ACCIDENTS. NO DRUG ALLERGY.

    30. Minimal time of anaesthesia effects: ( painless time ) : 11.30 hours. Maximal time of anaesthesia effects: ( painless time ) : 18.00 hours.

    32. RESULTS & BENEFITS. BETTER RELATIONSHIP... between CHILD and SURGEON. BETTER RELATIONSHIP... between CHILD and NURSING STAFF. BETTER RELATIONSHIP... between PARENTS and NURSING STAFF. LESS INTERPERSONAL CONFLICTS... DURING HOSPITALIZATION. OUTSTANDING PROTECTION... FOR YOUNG PACIENT’S ORGANISM. ( due to a smaller consumption of analgetics. ) SIGNIFICANT... SAVINGS.

    34. CHILD WITHOUT PAIN… IS RELAXED, HAPPY AND SMILES !.. IF EVEN THOUGH… PASSED SURGERY.

    35. THAT ? THIS ?

    36. CHILDREN DESERVE THE OFFER OF NEWEST METHODS TO TREAT POSTOPERATIVE PAIN THEY HAVE THE RIGHT TO A PAINLESS POSTOPERATIVE STATUS SURGEONS HAVE THE OBLIGATION TO FULFIL BOTH , IN SPITE OF OLD CONCEPTS CURRENTLY STILL BEING APPLIED

    37. UPORABA METODE INFILTRACIJE OPERATIVNE RANE Z DOLGOTRAJNIM LOKALNEM ANESTETIKOM PRI OTROCIH KAŽE, DA JE : UCEN POVAR ZAKLJUCEK :

    38. UC INKOVIT. EN OSTAVEN. PO CENI. VAR EN.

    39. INFILTRATION OF THE OPERATIVE WOUND WITH LEVOBUPIVACAINE IN PEDIATRIC SURGERY IS: CH E S S CONCLUDING :

    40. CH EAP. E FFECTIVE. S AFE. S IMPLE.

    41. THANKS FOR YOUR ATTENTION !..

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