Serum Levels of Endocannabinoids and Related N-Acyl-Ethanolamides in Children during Multimodal Anesthesia
2Intensive Care Unit, University Children’s Hospital, Poland
3Department of Medical Biochemistry, Wroclaw Medical University, Poland
4The Area of Analytics, Polish Center for Technology Development, Poland
5Department of Anesthesiology and Intensive Care, Jagiellonian University Medical College, Poland
Background: Post-operative pain is a major and one of the most common after effect of the surgery. The novel therapeutic opportunities are connected with intra-venous (i.v.) lidocaine administration as a part of multimodal analgesia.
Objective: We analyzed the influence of intra-operative, i.v. lidocaine infusion in children on serum concentrations of selected endocannabinoids: anadanamide (AEA) and 2-arachidonoyl glycerol (2-AG) as well as N-acylethanolamines (NAEs), palmitoylethanolamide (PEA) and oleoylethanolamide (OEA).
Methods: Forty–four children undergoing major spinal surgery were enrolled in the cohort study. They were divided into two groups: generally anesthetized with lidocaine as co-analgesic (lidocaine group; LG; n=23) and generally anesthetized without lidocaine (non-lidocaine group, NLG; n=21). We also recruited 23 healthy age- and gender-matched children (control group, CG). Blood samples were collected prior to surgery beginning, at the end of surgery, 6 hours after surgery and 14-16 after surgery (next day morning). In healthy children, a blood sample was collected once. In all samples, endocannabinoids were determined in using UPLC/MS analysis. We also measured pain intensity by 10-point Numerical Rating Scale (NRS) or Comfort Faces Scale in patients at rest and during coughing.
Results: The concentrations of measured compounds were comparable in control and in studied groups before surgery. We noted elevated serum concentration of AEA in the postoperative period in LG patients. We also reported that the level of the 2-AG was significantly lower in the LG patients, and was negatively correlated with lidocaine concentration and positively correlated with pain intensity. The highest concentration of PEA was observed in LG patients at 6h after the operation and only at that time was significantly elevated when compared to the NLG patients.
Conclusions: Associations between peripheral endocannabinoid levels, postoperative pain, and type of multimodal analgesia suggest that endocannabinoids should be considered as a target for the novel, more efficient pain relief therapy in children.
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