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Wejjakul W, Tangwiwat S, Pangthipampai P, Halilamien P, Eamsobhana P. Does ultrasound-guided popliteal-sciatic nerve block have superior pain control in pediatric foot and ankle surgery? A randomized control trial. J Orthop Sci 2022; 27:844-849. [PMID: 34052081 DOI: 10.1016/j.jos.2021.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/26/2021] [Accepted: 04/14/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Tendon surgery in the pediatric foot and ankle could cause severe postoperative pain, which may lead to psychologic distress and chronic pain. This study was aimed to compare the efficacy of a peripheral nerve block (PNB) and local surgical site infiltration (LSI) in pediatric foot and ankle tendon surgery. METHODS Forty pediatric patients, who underwent foot and ankle tendon surgery were enrolled. Patients age 1-6 years old were allocated to group 1 and 7-15 years old were group 2. The popliteal-sciatic nerve block with 0.5% Bupivacaine (0.25 ml/kg) for group 1A and 2A. Group 1B and 2B received 0.5% Bupivacaine (0.25 ml/kg) local injection before wound closure. Pain score was recorded using CHEOPS in 1-6 years (Group1A, 1B), NRS in age 7-15 years (Group 2A, 2B). The post-operative morphine consumption and complications were recorded. RESULTS For 7-15 years, pain score in group 2B was more than group 2A at postoperative 2 and 6 h [Mean difference (95% CI); -3.4 (-6.4 to -0.3), and -2 (-4.4 to 0.5), respectively], and reached MCID of 2. The number of morphine consumption was significantly higher in group 2 B at 0-6 and 6-12 h post-operatively [Mean difference (95% CI); -0.8 (-1.4 to -0.2), and -0.6 (-1.1 to -0.1), respectively, with p-value < 0.05]. For 1-6 years, there was no significant difference in pain score and number of postoperative morphine consumption. CONCLUSIONS PNB and LSI provided effective pain management in patients aged 1-6 years old with no statistically significant difference. PNB showed significant superior pain control in patients aged 7-15 years old.
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Affiliation(s)
- Witchuree Wejjakul
- Department of Orthopedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok 10700, Thailand.
| | - Suwimon Tangwiwat
- Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok 10700, Thailand.
| | - Pawinee Pangthipampai
- Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok 10700, Thailand.
| | - Pathom Halilamien
- Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok 10700, Thailand.
| | - Perajit Eamsobhana
- Department of Orthopedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok 10700, Thailand.
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Abstract
The scope of pediatric regional anesthesia is expanding, with increased safety and efficacy data over the past few years. As familiarity and expertise has developed with ultrasonography, regional anesthesia has played an important role in the management of acute pain in the postsurgical population.
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Ultrasonographic Assessment of Bladder Volumes in Children Undergoing Penile Surgery: Does the Type of Anesthesia Matter? Am J Ther 2019; 26:e314-e320. [PMID: 28767453 DOI: 10.1097/mjt.0000000000000632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND There are scant data reporting postoperative ultrasonographically measured bladder volumes in children undergoing penile surgery. STUDY QUESTION We studied the effect of various anesthesia techniques on return of micturition after penile surgery in children, using ultrasonographically measured bladder volumes. DATA SOURCES Ultrasonographically measured postvoiding residual bladder volumes indexed to age-appropriate capacity, and time elapsed between the end of surgery and spontaneous voiding after pediatric circumcision, distal hypospadias repair, or repair of urethrocutaneous fistula, were studied. STUDY DESIGN Children between 4 months and 12 years were randomized to caudal block, intravenous (IV) fentanyl or penile block, in association with inhaled general anesthesia. Bladder volumes were measured before surgery and immediately after voiding for the first time. Time to first postsurgery void was also recorded. RESULTS Thirty-one children completed all assessments; 12 underwent caudal block, 9 IV fentanyl anesthesia, and 7 were given penile block. The mean first postvoid bladder residual volumes were highest in the caudal and lowest in the penile block children (27.5 vs. 17.3 mL, P = 0.003). The time elapsing between the end of surgery and first voiding was the longest in the fentanyl group compared with caudal and penile blocks (232, 178, 150 minutes, respectively, P = 0.02). CONCLUSIONS None of the anesthetic techniques provoked postoperative urinary retention after minor penile surgery in children. The penile block appears superior to caudal block or to IV fentanyl-based anesthesia with regard to postoperative recovery of normal micturition.
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Current Evidence for Acute Pain Management of Musculoskeletal Injuries and Postoperative Pain in Pediatric and Adolescent Athletes. Clin J Sport Med 2019; 29:430-438. [PMID: 31460958 DOI: 10.1097/jsm.0000000000000690] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Sports-related injuries in young athletes are increasingly prevalent with an estimated 2.6 million children and adolescents sustaining a sports-related injury annually. Acute sports-related injuries and surgical correction of sports-related injuries cause physical pain and psychological burdens on pediatric athletes and their families. This article aims to evaluate current acute pain management options in pediatric athletes and acute pain management strategies for postoperative pain after sports-related injuries. This article will also elucidate which areas of pain management for pediatric athletes are lacking evidence and help direct future clinical trials. DATA SOURCES We conducted a literature search through PubMed and the Cochrane Central Register of Controlled Trials to provide an extensive review of initial and postoperative pain management strategies for pediatric sports-related musculoskeletal injuries. MAIN RESULTS The current knowledge of acute pain management for initial sports-related injuries, postoperative pain management for orthopedic surgeries, as well as complementary and alternative medical therapies in pediatric sports-related injuries is presented. Studies evaluating conservative management, enteral and nonenteral medications, regional anesthesia, and complementary medical therapies are included. CONCLUSIONS Adequate pain management is important for sports injuries in children and adolescents for emotional as well as physical healing, but a balance must be achieved to provide acceptable pain relief while minimizing opioid use and side effects from analgesic medications. More studies are needed to evaluate the efficacy of nonopioid analgesic medications and complementary therapies in pediatric patients with acute sports-related injuries.
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Zeng Y, Wan J, Ren H, Lu J, Zhong F, Deng S. The influences of anesthesia methods on some complications after orthopedic surgery: a Bayesian network meta-analysis. BMC Anesthesiol 2019; 19:49. [PMID: 30967113 PMCID: PMC6456996 DOI: 10.1186/s12871-019-0701-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 02/21/2019] [Indexed: 11/17/2022] Open
Abstract
Background Although several anesthesia procedures have been explored for orthopedic surgery, the complications of anesthesia remain not well resolved. This study aimed to explore the influence of different anesthesia methods on the complications after orthopedic surgery. Methods According to the searching strategy, anesthesia associated studies in orthopedic surgery were screened from Pubmed, Embase, and the Cochrane Library up to Mar. 10th, 2018. Then, complications and demographic data were extracted and quality of studies was assessed using Cochrane Collaboration recommendations. ADDIS software was used to perform the network meta-analysis. Pooled effect size was calculated using random effective model or consistency model, and presented with odds ratio (OR) and 95% confidence interval (CI). Results According to the selective criteria, a total of 23 studies with 2393 patients were enrolled in this study. Quality assessment revealed all studies had an ordinary quality. Network meta-analyses revealed that nerve block analgesia (NBA) presented a lower effect on the occurrence of post-operative nausea or vomiting (PONV; OR = 0.17, 95% CI: 0.06–0.39) and urine retention (OR = 0.07, 95% CI: 0.01–0.37) compared with epidural anesthesia (EA). Interscalene block (ISB) and local infiltration analgesia (LIA) could significantly reduce the occurrence of back pain compared with EA (OR = 0.00, 95% CI = 0.00–0.30; OR = 0.00, 95% CI = 0.00–0.25). Conclusion NBA presented an effective role in reliving the occurrence of PONV and urine retention, and ISB and LIA relieved the back pain compared with EA after orthopedic surgery.
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Affiliation(s)
- Yuqing Zeng
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, 16 Jichang Road, Baiyun District, Guangzhou, 510405, Guangdong Province, People's Republic of China.,Department of Orthopaedics, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang Province, People's Republic of China
| | - Junming Wan
- Department of Orthopaedics, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang Province, People's Republic of China
| | - Haiyong Ren
- Department of Orthopaedics, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang Province, People's Republic of China
| | - Jianwei Lu
- Department of Orthopaedics, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang Province, People's Republic of China
| | - Fuhua Zhong
- Department of Orthopaedics, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang Province, People's Republic of China
| | - Shu Deng
- Department of Hematology, The First Affliated Hospital of Zhejiang Chinese Medical University, 54 Youdian Road, Hangzhou, Zhejiang Province, People's Republic of China.
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Taylor MA, Parekh SG. Optimizing Outpatient Total Ankle Replacement from Clinic to Pain Management. Orthop Clin North Am 2018; 49:541-551. [PMID: 30224015 DOI: 10.1016/j.ocl.2018.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Outpatient total ankle arthroplasty is a potential significant source of cost savings. The ability to institute an effective outpatient total ankle program depends on appropriate patient selection, surgeon experience with total ankle replacement, addressing preoperative patient expectations, the involvement of an experienced multidisciplinary care team including experienced anesthesiologists, nurse navigators, recovery room nursing staff and physical therapists, and most importantly, such a program requires complete institutional logistical support.
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Affiliation(s)
- Michel A Taylor
- Department of Orthopaedic Surgery, Duke University Medical Center, 2301 Erwin Road, Durham, NC 27710, USA
| | - Selene G Parekh
- Department of Orthopaedic Surgery, Duke University Medical Center, 2301 Erwin Road, Durham, NC 27710, USA; Duke Fuqua School of Business, 100 Fuqua Drive, Durham, NC 27708, USA; North Carolina Orthopedic Clinic, 3609 Southwest Durham Drive, Durham, NC 27707, USA.
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Matthews JH, Terrill AJ, Barwick AL, Butterworth PA. Venous Thromboembolism in Podiatric Foot and Ankle Surgery. Foot Ankle Spec 2018; 11:444-450. [PMID: 29338332 DOI: 10.1177/1938640017750256] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The extent to which podiatric surgeons follow venous thromboembolism guidelines is unknown. The aim of this study therefore, was 2-fold: (a) to determine the rate of venous thromboembolism following podiatric surgery and (b) to investigate the factors that influence the use of thromboprophylaxis. METHODS Data from 4238 patients who underwent foot and ankle surgery over 2 years were analyzed. Venous thromboembolism within the first 30 days following surgery was recorded using the Australasian College of Podiatric Surgeons surgical audit tool. Logistic regression analyses were undertaken to determine the factors that influenced thromboprophylaxis. RESULTS Of the 4238 patient records, 3677 records (87%) provided complete data (age range 2-94 years; mean ± SD, 49.1 ± 19.7 years; 2693 females). A total of 7 venous thromboembolic events (0.2% rate) were reported. Operative duration and age (OR 12.63, 95% CI 9.47 to 16.84, P < 0.01), postoperative immobilization (OR 6.94, 95% CI 3.95 to 12.20, P < 0.01), and a prior history of VTE (OR 3.41, 95% CI 1.01 to 11.04, P = 0.04) were the strongest predictors of thromboprophylaxis. CONCLUSION Podiatric foot and ankle surgery is associated with a low rate of venous thromboembolism. This may be due in part to the thromboprophylaxis regime implemented by podiatric surgeons, which closely aligns with current evidence-based guidelines. LEVELS OF EVIDENCE Level II: Prospective cohort study.
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Affiliation(s)
- Jemma H Matthews
- School of Health and Human Sciences, Southern Cross University, Bilinga, Queensland, Australia (JHM, AJT, ALB, PAB).,Australasian College of Podiatric Surgeons, Melbourne, Victoria, Australia (PAB).,Faculty of Podiatric Medicine, Royal College of Physicians and Surgeons Glasgow, Glasgow, Scotland (PAB)
| | - Alexander J Terrill
- School of Health and Human Sciences, Southern Cross University, Bilinga, Queensland, Australia (JHM, AJT, ALB, PAB).,Australasian College of Podiatric Surgeons, Melbourne, Victoria, Australia (PAB).,Faculty of Podiatric Medicine, Royal College of Physicians and Surgeons Glasgow, Glasgow, Scotland (PAB)
| | - Alex L Barwick
- School of Health and Human Sciences, Southern Cross University, Bilinga, Queensland, Australia (JHM, AJT, ALB, PAB).,Australasian College of Podiatric Surgeons, Melbourne, Victoria, Australia (PAB).,Faculty of Podiatric Medicine, Royal College of Physicians and Surgeons Glasgow, Glasgow, Scotland (PAB)
| | - Paul A Butterworth
- School of Health and Human Sciences, Southern Cross University, Bilinga, Queensland, Australia (JHM, AJT, ALB, PAB).,Australasian College of Podiatric Surgeons, Melbourne, Victoria, Australia (PAB).,Faculty of Podiatric Medicine, Royal College of Physicians and Surgeons Glasgow, Glasgow, Scotland (PAB)
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In-Plane Ultrasound-Guided Lumbar Plexus Block Using Catheter-Over-Needle Technique in a 14-Month-Old Baby. Reg Anesth Pain Med 2016; 41:538-41. [DOI: 10.1097/aap.0000000000000417] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Chen JY, Li N, Xu YQ. Single Shot Adductor Canal Block for Postoperative Analgesia of Pediatric Patellar Dislocation Surgery: A Case-Series Report. Medicine (Baltimore) 2015; 94:e2217. [PMID: 26632911 PMCID: PMC4674214 DOI: 10.1097/md.0000000000002217] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Postoperative analgesia for the knee surgery in children can be challenging. Meanwhile acute pain management in pediatric patients is still often undertreated due to inadequate pain assessment or management. We reported the ultrasound-guided single-injection adductor canal block (ACB) with 0.2% ropivacaine and dexmedetomidine (0.5 μg/kg) in addition in a series of 6 children. Patients' age was range from 7 to 15 years old with right or left habitual patellar dislocation needing an open reduction and internal refixation. Pain assessments using Numeric Rating Scale scores on the operative limb were made preoperatively and at 12, 24, 36, and 48 h postoperatively at rest. Medication consumption was calculated as well. The possible complications, such as hemodynamic changes, nausea, vomiting, and dysesthesia, were also recorded at 12, 24, 36, and 48 h postoperatively at rest. The pain scores were low, and analgesic medication consumption was minimal. Meanwhile, no adverse events were recorded in any of the subject. Single-injection ACB might be an optimal analgesia strategy for patellar dislocation surgery in pediatric patients.
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Affiliation(s)
- Jia-Yu Chen
- From the Department of Orthopedics (J-YC, Y-QX) and Department of Anesthesiology (NL), Kunming General Hospital of Chengdu Military Region, Kunming, Yunnan, China
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Walker B, Long J, De Oliveira G, Szmuk P, Setiawan C, Polaner D, Suresh S. Peripheral nerve catheters in children: an analysis of safety and practice patterns from the pediatric regional anesthesia network (PRAN). Br J Anaesth 2015; 115:457-462. [DOI: 10.1093/bja/aev220] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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A Randomized Study to Compare the Analgesic Efficacy of Ultrasound-Guided Block of Fascia Iliaca Compartment or Femoral Nerve After Patella Fracture Surgery. Cell Biochem Biophys 2015; 72:567-70. [DOI: 10.1007/s12013-014-0503-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Bösenberg AT. New developmentsin paediatric regional anaesthesia. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2014. [DOI: 10.1080/22201173.2008.10872528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
The use of regional anesthesia in children is increasing. Rapid advancement in the use of ultrasound guidance has allowed for a greater ease in performing peripheral regional anesthesia in pediatrics. Successful peripheral nerve blockade provides children with analgesia that will improve their operative experience.
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Affiliation(s)
- Santhanam Suresh
- Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, 225 East Chicago Avenue, Box 19, Chicago, IL 60611, USA.
| | - Amod Sawardekar
- Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, 225 East Chicago Avenue, Box 19, Chicago, IL 60611, USA
| | - Ravi Shah
- Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, 225 East Chicago Avenue, Box 19, Chicago, IL 60611, USA
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Abstract
Advances in the field of paediatric regional anaesthesia have specific applications to both acute and chronic pain management. This review summarizes data regarding the safety of paediatric regional anaesthetic techniques. Current guidelines are provided for performing paediatric regional techniques, with a focus on applications for postoperative pain management. Brief descriptions of relevant anatomy followed by indications for commonly performed blocks are highlighted along with the potential of adverse side-effects.
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Affiliation(s)
- R D Shah
- Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
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Restrepo-Garces CE, Saldarriaga NE, Jaramillo S, Gomez CM, Vargas JF, Ramirez LJ. Ganglion impar phenol injection in a pediatric patient with refractory cancer pain. PAIN MEDICINE 2013; 15:334-6. [PMID: 24224948 DOI: 10.1111/pme.12274] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Carlos Eduardo Restrepo-Garces
- Surgical Department & Image Guided Service, Hospital Pablo Tobon Uribe, Medellin, Antioquia, Colombia; Anesthesia & Pain Clinic, Clinica Las Americas, Medellin, Antioquia, Colombia
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Dillow JM, Rosett RL, Petersen TR, Vagh FS, Hruschka JA, Lam NCK. Ultrasound-guided parasacral approach to the sciatic nerve block in children. Paediatr Anaesth 2013; 23:1042-7. [PMID: 23683056 DOI: 10.1111/pan.12194] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/19/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND The parasacral (PS) approach to sciatic nerve blockade has the potential for safe and effective use in children, but has never been studied in this population. Its potential advantages include increased posterior cutaneous nerve block reliability, potential for hip joint analgesia, and decreased nerve depth, making ultrasound guidance easier. OBJECTIVE To assess the efficacy of an ultrasound-guided PS sciatic nerve block in children. METHODS Nineteen patients, 1-16 years old, scheduled for lower limb surgery with peripheral nerve blockade (PNB) were prospectively enrolled. A PS sciatic block was performed using both ultrasound guidance and nerve stimulation, and 0.5 ml·kg(-1) ropivacaine 0.2% (maximum 20 ml) was administered. Patient demographics, the time to perform the block, the lowest intensity of nerve stimulation, evoked response, identification of gluteal arteries, and amount of narcotic given were recorded. Postoperatively, pain scores, block success or failure, block duration, and complications were recorded. RESULTS The block was performed using the PS approach in 95% of the cases. The success rate was 100% in the PS sciatic blocks performed. The pain scores for all patients in the first postsurgical hour were zero, except one patient that had a pain score of 3 of 10 at 30 min; his pain improved to 0 of 10 after administration of one dose of fentanyl and distraction techniques. The blocks lasted 17.3 ± 5.4 h. No complications were identified. CONCLUSION The PS approach is an effective option for sciatic nerve blockade to provide postoperative pain relief in children having lower extremity surgery.
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Affiliation(s)
- Jennifer M Dillow
- Department of Anesthesiology & Critical Care Medicine, University of New Mexico Hospital, Albuquerque, NM, USA
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Abstract
Regional anesthesia for blockade of the sciatic nerve in the popliteal fossa is a useful adjunct to pain management in the perioperative setting for foot and ankle surgeons. The present tip aimed to provide a review of the relevant anatomy and technique for popliteal nerve block from the posterior and lateral approaches and to provide discussion and images of the use of peripheral nerve stimulation and ultrasound guidance as adjuvant methods to improve efficacy and reproducibility.
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Affiliation(s)
- Corine Creech
- Temple University Hospital Podiatric Surgical Residency Program, Philadelphia, Pennsylvania, USA
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Gallardo J, Lagos L, Bastias C, Henríquez H, Carcuro G, Paleo M. Continuous popliteal block for postoperative analgesia in total ankle arthroplasty. Foot Ankle Int 2012; 33:208-12. [PMID: 22734282 DOI: 10.3113/fai.2012.0208] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Total ankle arthroplasty is associated with severe postoperative pain. Development of analgesic techniques such as a block with continuous infusion at the popliteal level has been shown to result in good pain control, a decrease in the use of rescue analgesia and a low rate of complications. We reviewed our experience with this method of analgesia in patients who underwent total ankle arthroplasty. METHODS A prospective study of 30 patients undergoing total ankle arthroplasty was carried out. Twenty-two of these received and maintained a block at the popliteal level with a continuous infusion of bupivacaine, while the remaining eight received no such block. RESULTS The visual analog scale evaluation (VAS) showed a significant improvement in pain control in the group with the popliteal block after 6, 12, 18, and 24 hours postsurgery, with pain levels peaking and being most different between 6 and 12 hours postsurgery for the two groups. The group with the popliteal block also exhibited a significantly lower consumption of morphine and a greater degree of patient satisfaction. CONCLUSION The block with continuous infusion at the popliteal fossa was a safe technique for total ankle arthroplasty postoperative analgesia, which provided good pain control, a lower requirement of opiates and a higher level of patient satisfaction.
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Affiliation(s)
- Jorge Gallardo
- Instituto Traumatológico, Foot and Ankle Service, San Martin 771, Santiago de Chile 8340220, Chile
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Abstract
The strategies used to manage children exposed to long-term opioids are extrapolated from adult literature. Opioid consumption during the perioperative period is more than three times that observed in patients not taking chronic opioids. A sparing use of opioids in the perioperative period results in both poor pain management and withdrawal phenomena. The child's pre-existing opioid requirement should be maintained, and acute pain associated with operative procedures should be managed with additional analgesia. This usually comprises short-acting opioids, regional or local anesthesia, and adjuvant therapies. Long-acting opioids, transdermal opioid patches, and implantable pumps can be used to maintain the regular opioid requirement. Intravenous infusion, nurse controlled analgesia, patient-controlled analgesia, or oral formulations are invaluable for supplemental requirements postoperatively. Effective management requires more than simply increasing opioid dose during this time. Collaboration of the child, family, and all teams involved is necessary. While chronic pain or palliative care teams and other staff experienced with the care of children suffering chronic pain may have helpful input, many pediatric hospitals do not have chronic pain teams, and many patients receiving long-term opioids are not palliative. Acute pain services are appropriate to deal with those on long-term opioids in the perioperative setting and do so successfully in many centers. Staff caring for such children in the perioperative period should be aware of the challenges these children face and be educated before surgery about strategies for postoperative management and discharge planning.
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Affiliation(s)
- Tim Geary
- Department of Anaesthesia, Starship Children's Hospital, Auckland, New Zealand
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Abstract
With ultrasound, continuous peripheral nerve blocks (CPNBs) are one of the most recent developments in regional anesthesia in children. CPNBs are now used more widely in children because more suitable materials have been marketed, allowing complete, and prolonged postoperative pain control. Their use after orthopedic procedures in children and treatment for complex regional pain syndrome in adolescents has demonstrated the benefits. Perineural catheters have also shown their superiority over other techniques of continuous regional anesthesia in terms of side effects. The efficiency and the safety of these techniques may facilitate early ambulation with improved pain management, treatment at home with disposable pumps, and improved rehabilitation of children. Studies on large cohorts of patients published to date have failed to highlight any severe complications in their use compared with other adult studies. Accidents owing to systemic toxicity are very unlikely if the recommended maximum dose is not exceeded. The safety of continuous regional anesthesia techniques in children relies on the use of low-concentration l-enantiomer solutions (ropivacaine or levobupivacaine) accompanied by low plasma concentrations of local anesthetics, limiting the risk of systemic toxicity of these molecules. CPNB can ensure strong and lasting analgesia in hospital or at home.
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Affiliation(s)
- Christophe Dadure
- Department of Anaesthesia and Critical Care Unit, Lapeyronie University Hospital, Montpellier, France.
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Continuous infusion of bupivacaine reduces postoperative morphine use in adolescent idiopathic scoliosis after posterior spine fusion. Spine (Phila Pa 1976) 2011; 36:1478-83. [PMID: 20881514 DOI: 10.1097/brs.0b013e3181f352d1] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective analysis. OBJECTIVE To determine if an infusion of bupivacaine will reduce the need for intravenous opioids following posterior spine fusion. SUMMARY OF BACKGROUND DATA Adolescent idiopathic scoliosis is estimated to occur with a frequency of 1% to 3% among the at-risk age group of 10 to 18 years. A small percentage of these patients will require surgical intervention. Data are limited regarding continuous infusion of local anesthetic after posterior spine fusion for pain control. METHODS.: Retrospective review of children 10 to 18 years with idiopathic scoliosis admitted to a tertiary care, 20-bed pediatric intensive care unit (P pediatric intensive care unit), following posterior spine fusion. The primary outcome was postoperative opioid use stratified by the presence of a catheter for continuous bupivacaine. Secondary outcomes included pain scores, side effect management, depth of catheter placement, and fluid resuscitation. RESULTS Two hundred and forty-four children were eligible, 129 received a catheter for continuous bupivacaine, 115 did not. There were no differences in demographics. Significantly fewer patients receiving bupivacaine required a continuous basal infusion of morphine (32.6% vs. 85.2%, P < 0.001) resulting in an overall reduction opioid use on postoperative day 1 (18.9 vs. 26.4 mg, P < 0.001). Overall, pain scores were low in both groups. Limiting the analysis to only those with a bupivacaine catheter, the depth of catheter placement did not impact postoperative opioid use (P > 0.15). CONCLUSION The use of a continuous infusion of bupivacaine provided good analgesia with low pain scores. The significant reduction in basal morphine use may reflect a replacement by bupivacaine, although this is limited by potential treatment bias. Multivariate analysis was required to control for ongoing changes in anesthesia practice over the many years of the study. The optimal depth of catheter placement is unclear from this analysis and should be studied prospectively.
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Ecoffey C, Lacroix F, Giaufré E, Orliaguet G, Courrèges P. Epidemiology and morbidity of regional anesthesia in children: a follow-up one-year prospective survey of the French-Language Society of Paediatric Anaesthesiologists (ADARPEF). Paediatr Anaesth 2010; 20:1061-9. [PMID: 21199114 DOI: 10.1111/j.1460-9592.2010.03448.x] [Citation(s) in RCA: 202] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The French-Language Society of Paediatric Anaesthesiologists (ADARPEF) designed a 1-year prospective, multicenter and anonymous study to update both epidemiology and morbidity of regional anesthesia in children. METHODS From November 2005 to October 2006, data from participating hospitals were recorded using an identification form, a data recording form, and a complication form. Information collected included the characteristics of the hospitals, the number and type of regional anesthetics (RA), the age of the involved children as well as the incidence, and type of complications. RESULTS Data collected in 47 institutions included 104,612 pure general anesthesias (GAs), 29,870 GAs associated with regional blocks, and 1262 pure regional blocks. Central blocks accounted for 34% of all RA. Peripheral blocks (66%) were upper or lower limb blocks (29% of peripheral blocks), trunk blocks, and face blocks (71%). In children aged ≤3 years, the percentage of central blocks was similar to the peripheral ones (45% vs 55), while in older children, peripheral blocks were more than four times used than central ones. Complications (41 involving 40 patients) were rare and usually minor. They did not result in any sequelae. The study revealed an overall rate of complication of 0.12%; CI 95% [0.09-0.17], significantly six times higher for central than for peripheral blocks. CONCLUSIONS As a result of the low rate of complications, RA techniques have a good safety profile and can be used to provide postoperative analgesia. In addition, the results should encourage anesthesiologists to continue to use peripheral instead of central (including caudal) blocks as often as possible when appropriate.
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Affiliation(s)
- Claude Ecoffey
- Service d'Anesthésie Réanimation Chirurgicale 2, Hôpital Pontchaillou, Université de Rennes 1, Rennes, France.
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Dadure C, Bringuier S, Mathieu O, Raux O, Rochette A, Canaud N, Javitary W, Capdevila X. Analgésie péridurale continue versus bloc continu du compartiment psoas pour l’analgésie postopératoire après chirurgie majeure du bassin ou du fémur chez l’enfant : étude prospective comparative randomisée. ACTA ACUST UNITED AC 2010; 29:610-5. [DOI: 10.1016/j.annfar.2010.05.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2009] [Accepted: 05/25/2010] [Indexed: 11/30/2022]
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de José María B. [Regional anesthesia in children]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2010; 57:402-403. [PMID: 20857634 DOI: 10.1016/s0034-9356(10)70265-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Jonnavithula N, Durga P, Madduri V, Ramachandran G, Nuvvula R, Srikanth R, Damalcheruvu MR. Efficacy of palatal block for analgesia following palatoplasty in children with cleft palate. Paediatr Anaesth 2010; 20:727-33. [PMID: 20670236 DOI: 10.1111/j.1460-9592.2010.03347.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND This prospective randomized controlled study was undertaken to evaluate the efficacy of palatal block i.e. blocking of naso palatine, greater and also lesser palatine nerves in children with cleft palate undergoing palatoplasty by evaluating its effects on intraoperative anesthetic requirement, postoperative analgesia and parental satisfaction. METHODS Forty-five pediatric patients aged below five undergoing cleft palate repair were randomly allocated to three groups of 15 each. After tracheal intubation, Group NB received no block for control, group S received 0.5 ml of normal saline and group B received 0.5 ml of 0.25% bupivacaine for palatal block. Postoperative pain score, the time to first demand of analgesia and number of rescue analgesic demands were noted. Finally, the parental satisfaction was graded. RESULTS The block had no anesthetic sparing effect. The mean pain scores were significantly lower in patients who received block than in the group NB. The mean area under curve for FLACC score in group NB was 29 with 95% CI of 25-32, group S was 15 with 95% CI of 8.9-22.3 and in group B, it was 10 with 95% CI of 6-14. The time to first demand of analgesia was 6 [4.5-6] h in group NB, 18 [6-18] h in group S and 18 [18-18] h in group B (P-0.000). The number of demands of rescue analgesia was significantly less in group B 0 [0-0.25], 0 [0-2] in S group compared to group NB 3 [3-3] (P-0.000). The parental satisfaction was good in patients who received block and poor in group NB. CONCLUSION Palatal block is technically simple, safe and effectively provides postoperative analgesia with good parental satisfaction. Injection of saline also produced palatal nerve block; however, the effect was not consistent.
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Affiliation(s)
- Nirmala Jonnavithula
- Department of Anesthesiology, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Andhra Pradesh, India.
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Willschke H, Marhofer P, Machata AM, Lönnqvist PA. Current trends in paediatric regional anaesthesia. Anaesthesia 2010; 65 Suppl 1:97-104. [DOI: 10.1111/j.1365-2044.2010.06242.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Reske AW, Reske AP, Meier V, Wiegel M. [Peripheral nerve blocks of the lower extremities. Clinical and practical aspects]. Anaesthesist 2009; 58:1055-70; quiz 1071. [PMID: 19812903 DOI: 10.1007/s00101-009-1610-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Peripheral nerve blocks (PNBs) of the lower extremities are effective techniques for anesthesia and postoperative pain control. So far, these techniques have been used less frequently than PNBs of the upper limb. Nevertheless, growing awareness of complications of neuroaxial techniques, improved equipment and modern techniques for nerve localization have led to an increased use of PNBs of the lower limb. Anesthesiologists should be familiar with the anatomical basics and procedural details of these PNBs. They should also know the typical complications and side-effects and thoroughly inform patients about such potential problems. Continuous PNBs (perineural catheters) allow the benefits of PNBs to be prolonged into the postoperative period. Compared to continuous neuroaxial techniques continuous PNBs are equally effective for pain control but seem to be associated with fewer complications and side-effects.
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Affiliation(s)
- A W Reske
- Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Carl Gustav Carus, Fetscherstrasse 74, 01307, Dresden.
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Dadure C, Bringuier S, Raux O, Rochette A, Troncin R, Canaud N, Lubrano-Lavadera JF, Capdevila X. Continuous peripheral nerve blocks for postoperative analgesia in children: feasibility and side effects in a cohort study of 339 catheters. Can J Anaesth 2009; 56:843-50. [PMID: 19697092 DOI: 10.1007/s12630-009-9169-8] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2009] [Accepted: 08/06/2009] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Perioperative continuous peripheral nerve blocks (CPNB) are increasingly being used in children. Only one previous study has reported adverse events of CPNB in a high number of pediatric cases. We evaluated the indications, block efficacy, and adverse events related to CPNB in children. METHODS All CPNBs that were performed in children for postoperative analgesia over a 5-year period at the Montpellier University Hospital in France were included in this study. The first bolus dose and the continuous doses of local anesthetic were not standardized. In the postoperative period, demographic data, quality of analgesia, amount of rescue analgesic medication, child/parent satisfaction, and adverse events were recorded in our Departmental Regional Anesthesia registry. RESULTS A total of 339 catheters were evaluated in 292 children ASA physical status I to III. The median age was 8 yr (0.6-17 yr) and the median weight was 28 kg (7-116 kg). The main surgical indications were hip, femoral, or tibial osteotomies (44.5%) and club foot repair (27.4%). The local anesthetics used were either bupivacaine or ropivacaine. The mean volume of the local anesthetic bolus dose was 0.49 +/- 0.16 mL . kg(-1), and the mean regimen of local anesthetic continuous infusion was 0.11 +/- 0.04 mL . kg(-1) . hr(-1). The median duration of CPNB was 61.6 hr (range 0-264 hr). Pain relief, which was evaluated with the children at rest, was considered optimal in the majority of patients throughout the study period. The Children and Infants Postoperative Pain Scale (CHIPPS) was used in children age 0-6 yr and the Visual Analog Pain Scale (VAS) was used in children 7 yr and older. There were no major adverse events. There were 211 minor adverse events recorded in 153 CPNBs (45.1%). The most frequently reported complication (20.1%) involved mechanical problems with the catheter, followed by nausea and vomiting (14.7%). CONCLUSION CPNBs are indicated after orthopedic surgery in children. Our results demonstrate that CPNBs are feasible in the pediatric setting, and in skilled hands, they promote prolonged analgesia in the majority of patients without major adverse events. The most common minor adverse events are catheter-related mechanical problems and postoperative nausea and vomiting.
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Affiliation(s)
- Christophe Dadure
- Department of Anesthesia and Critical Care Medicine, Lapeyronie University Hospital, Montpellier, France.
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Stojadinovic A, Shockey SM, Croll SM, Buckenmaier CC. Quality of reporting of regional anesthesia outcomes in the literature. PAIN MEDICINE 2009; 10:1123-31. [PMID: 19671083 DOI: 10.1111/j.1526-4637.2009.00683.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Consistent and reliable standards for reporting of regional anesthetic adverse events are lacking. The quality of reporting of regional anesthetic morbidity has not been assessed critically. AIM To evaluate quality of regional anesthesia outcomes reporting. Methods. Published retrospective or prospective observational cohort or randomized controlled trials in peer-reviewed journals were reviewed, and judged according to seven criteria related to quality of reporting of regional anesthesia complications: method of accrual, duration of data collection, definition of complication, morbidity and mortality rates, grade of complication severity, exclusion criteria, and study follow up. Differences in reporting outcomes according to study design, sample size and time period were compared. RESULTS Ninety-one articles published from 1996-2006 involving 8,833 patients were analyzed. The majority of studies (75%) met < or =4 reporting criteria. Recently published, prospective studies with >200 patients were associated with significantly higher-quality reporting (P < 0.05). Fewer than 50% of studies reported at least one recognized, accepted complication with defined criteria or indicated duration of follow up. Reporting compliance was worse (29%) for reporting of actual morbidity rates, and complications leading to death. Complication severity grading related to regional anesthesia was reported in 2% of studies. CONCLUSION Consistent and comparative regional anesthesia outcome data are lacking in peer-reviewed journals. A graded regional anesthetic morbidity and mortality system according to the intensity of therapy required for the treatment of the defined complication is proposed, along with a structured format for the reporting of regional anesthesia complications according to defined reporting standards.
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Affiliation(s)
- Alexander Stojadinovic
- Army Regional Anesthesia & Pain Management Initiative, Anesthesia & Operative Service, Walter Reed Army Medical Center, Washington, DC 20307-5001, USA
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Dadure C. [Postoperative pain management using regional anaesthesia in the child. Pain and Locoregional Anesthesia Committee and the Standards Committee of the French Society of Anesthesia and Intensive Care]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2009; 28:e67-e70. [PMID: 19186026 DOI: 10.1016/j.annfar.2008.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- C Dadure
- Département d'anesthésie-réanimation, CHU Lapeyronie, 375 avenue du Doyen-Gaston-Giraud, Montpellier cedex 5, France.
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Delaunay L, Plantet F, Jochum D. Échographie et anesthésie locorégionale. ACTA ACUST UNITED AC 2009; 28:140-60. [DOI: 10.1016/j.annfar.2008.12.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2008] [Accepted: 12/05/2008] [Indexed: 10/21/2022]
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Bernière J, Schrayer S, Piana F, Vialle R, Murat I. A new formula of age-related anatomical landmarks for blockade of the sciatic nerve in the popliteal fossa in children using the posterior approach. Paediatr Anaesth 2008; 18:602-5. [PMID: 18482231 DOI: 10.1111/j.1460-9592.2008.02634.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Anatomical landmarks for sciatic nerve blockade are poorly described in children. In adults, the site of puncture of the high approach is located at least 10 cm above the popliteal skin crease. METHODS We hypothesized that correcting the adult landmarks (10 cm) by the ratio of the calculated child femoral shaft length over the adult femoral shaft length would provide adequate landmarks for needle introduction for popliteal nerve block in children. RESULTS The theoretical landmarks were calculated and tested in 21 infants and children. In all cases, the sciatic nerve was easily located using the nerve stimulator when the needle was inserted at the calculated place and 29 catheters were successfully placed in these 21 children. CONCLUSION These simple landmarks adapted to children age are expected to help the clinicians to perform safely sciatic blocks at the popliteal fossa in young patients.
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Affiliation(s)
- Josée Bernière
- Department of Anesthesiology, Armand Trousseau Hospital, Pierre et Marie Curie University, Paris, France
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Howard R, Carter B, Curry J, Morton N, Rivett K, Rose M, Tyrrell J, Walker S, Williams G. Postoperative pain. Paediatr Anaesth 2008; 18 Suppl 1:36-63. [PMID: 18471177 DOI: 10.1111/j.1460-9592.2008.02431.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Grosser DM, Herr MJ, Claridge RJ, Barker LG. Preoperative lateral popliteal nerve block for intraoperative and postoperative pain control in elective foot and ankle surgery: a prospective analysis. Foot Ankle Int 2007; 28:1271-5. [PMID: 18173991 DOI: 10.3113/fai.2007.1271] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Limiting postoperative pain and minimizing systemic narcotic complications are important considerations in foot and ankle surgery to maximize patient comfort and promote early discharge from the hospital. Nerve blocks are valuable additions to perioperative care. A variety of nerve blocks have been advocated, but few reports have evaluated a preoperative supine approach for popliteal block in foot and ankle surgery. METHODS We prospectively evaluated the effectiveness of a preoperative popliteal block in 25 consecutive patients undergoing a variety of foot and ankle procedures, as well as the length of block coverage, patient satisfaction, and any complications. Patients were monitored clinically and by a questionnaire at various time increments: preoperatively, in the post-anesthesia care unit (PACU), postoperative day one, and postoperative week one. RESULTS Postoperatively, 15 of 25 patients had a complete block (motor and sensory), five of 25 patients demonstrated motor function, but denied sensation or pain, and the remaining five of 25 had sensation to light touch but no motor function or pain. None of the patients reported pain postoperatively in the PACU within an hour after surgery. The average time the block lasted was 14 hours. Overall satisfaction with the block on postoperative day one and week one was 4.8 out of 5. There were no intraneural injections, neurologic sequelae, or complications. CONCLUSIONS We suggest that a preoperative nerve block for a sedated patient in the operating room saves time, avoids patient discomfort, augments general anesthesia, provides good postoperative pain control, and has high patient satisfaction with no significant complications.
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Affiliation(s)
- Dawn M Grosser
- Orthopaedic Associates of Corpus Christi, 601 Texan Trail, Corpus Christi, TX 78411, USA.
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Rochette A, Dadure C, Raux O, Troncin R, Mailheé P, Capdevila X. A review of pediatric regional anesthesia practice during a 17-year period in a single institution. Paediatr Anaesth 2007; 17:874-80. [PMID: 17683407 DOI: 10.1111/j.1460-9592.2007.02217.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is anecdotal evidence of changes in pediatric regional anesthesia (RA) practice. We performed a retrospective review of prospective data on pediatric RA over 17 years in our institution. METHODS Data were collected from an electronic database for every anesthetic performed between 1989 and 2005. Type of RA, if any, and age of the patient were noted. Patients were divided into two groups: <or=4 years (younger group) and 5 years or older (older group). RESULTS A total of 51 408 anesthetics were performed; 23 609 (46%) in the younger group. A total of 10,929 RA were performed. In the younger group, RA increased from 9.5% to 27.6% (P<0.001). Neuraxial blocks decreased from 100% to 59.7% of RA. Caudals decreased in the late 1990s from 70% to 22% of RA and epidurals have decreased from 22% to 11% of RA since 2002. Neonatal spinals were introduced in 1990 and now reach 30% of RA. Peripheral blocks have increased up to 37% of RA since 1994. In the older group, RA increased from 9.2% to 23.3% (P<0.001), less than in the younger (P<0.01). Neuraxial blocks have decreased from 97% to 24.9% of RA (P<0.001), more obviously than in the younger group (P<0.001). Peripheral blocks emerged in 1994, outnumbering neuraxial blocks as early as 1995 and now account for 75% of RA. This increase is significantly more pronounced than in the younger group (P<0.001). In both groups, peripheral blocks were distributed among plexus blocks (30%) and compartment/peripheral nerve blocks (70%). In the last 5 years, a perineural catheter was placed in 12.9% of peripheral blocks to ensure continuous postoperative analgesia. CONCLUSIONS In our hospital, there has been a dramatic increase in RA, mainly from 1989 to 1995. The most remarkable events in the last decade were: (i) the change in practice from neuraxial to peripheral blocks and (ii) the emergence of continuous postoperative analgesia via perineural catheters.
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Affiliation(s)
- Alain Rochette
- Department of Anaesthesiology and Intensive Care Medicine A, Unviersity Hospital Lapeyronie, Montpellier, France.
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Abstract
PURPOSE OF REVIEW New topics in pediatric regional anesthesia are discussed. RECENT FINDINGS Continuous peripheral nerve blocks, new local anesthetics and the performance of regional blocks with ultrasonography guidance are summarized. SUMMARY Prolonged analgesia with continuous peripheral nerve blocks in the treatment of pediatric postoperative limb pain, sometimes with patient-controlled regional analgesia, should be preferred instead of continuous epidural analgesia. Levobupivacaine and ropivacaine display the same pharmacokinetic profile as racemic bupivacaine with less cardiac toxicity. Conversely, continuous infusion of these new local anesthetics offers the safest therapeutic index, especially in infants. Many adjuvants have been used, but clonidine offers clear advantages. Ultrasonography guidance blocks will probably become the reference technique for local anesthetics injection and regional anesthesia catheter placement; new training in this field should be available.
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Affiliation(s)
- Claude Ecoffey
- Service d'Anesthésie-Réanimation Chirurgicale 2, Université de Rennes 1, Hôpital Pontchaillou, Rennes, France.
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Zarucco L, Driessen B, Scandella M, Seco O, Cozzi F, Orsini JA. Continuous Perineural Block of the Palmar Nerves: A New Technique for Pain Relief in the Distal Equine Forelimb. ACTA ACUST UNITED AC 2007. [DOI: 10.1053/j.ctep.2007.05.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Habre W, Paut O. [Actualities in paediatric anaesthesia and critical care medicine]. ACTA ACUST UNITED AC 2007; 26:483-7. [PMID: 17544241 DOI: 10.1016/j.annfar.2007.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Current World Literature. Curr Opin Anaesthesiol 2007; 20:284-6. [PMID: 17479036 DOI: 10.1097/aco.0b013e3281e3380b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Pasero C, McCaffery M. Orthopaedic Postoperative Pain Management. J Perianesth Nurs 2007; 22:160-72; quiz 172-3. [PMID: 17543801 DOI: 10.1016/j.jopan.2007.02.004] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2007] [Accepted: 02/23/2007] [Indexed: 10/23/2022]
Abstract
Severe postoperative pain is common following orthopaedic surgery, and its safe and effective management can be challenging for everyone on the health care team. There are a variety of methods used to address orthopaedic postoperative pain and all incorporate the principles of multimodal analgesia. The purpose of this article is to provide an overview of the primary methods used to manage orthopaedic pain and describe the perianesthesia nurse's role in the administration of them.
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Dadure C, Capdevila X. Continuous Regional Anesthesia After Foot Surgery in Children. Anesth Analg 2007. [DOI: 10.1213/01.ane.0000253563.62198.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Setzer N. Continuous regional anesthesia after foot surgery in children. Anesth Analg 2007; 104:457; author reply 457. [PMID: 17242117 DOI: 10.1213/01.ane.0000253562.85060.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Dadure C, Capdevila X. [Perioperative analgesia with continuous peripheral nerve blocks in children]. ACTA ACUST UNITED AC 2006; 26:136-44. [PMID: 17174518 DOI: 10.1016/j.annfar.2006.10.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2005] [Accepted: 10/09/2006] [Indexed: 10/23/2022]
Abstract
Recently, regional anaesthesia in children has generated increasing interest. But single injection techniques have a limited duration of postoperative analgesia. Then, continuous peripheral nerve blocks have taken an important position in the anaesthetic arsenal, allowing an effective, safe and prolonged postoperative pain management. As adults, indications for continuous peripheral nerve blocks depend on the analysis of individual benefits/risks ratio. Main indications are intense postoperative pain surgical procedures, with or without postoperative rehabilitation, and complex regional pain syndrome. Contraindications to these procedures are rather similar to those in adults, plus parental and/or children refusal. Continuous peripheral nerve blocks are usually performed under general anaesthesia or sedation in children, and require appropriate equipment in order to decrease the risk of nerve injury. New techniques, such as transcutaneous nerve stimulation or ultrasound guidance, appeared to facilitate nerve and plexus approach identification in paediatric patients. Nevertheless, continuous peripheral nerve block may theoretically mask a compartment syndrome after trauma surgical procedures. Finally, ropivacaine appears to be the most appropriate drug for continuous peripheral nerve blocks in children, requiring low flow rates and concentrations of local anaesthetic. These techniques may facilitate early ambulation by an improved pain management or even postoperative analgesia at home with disposable pumps. One might infer from the current review that excellent pain relief coupled with a reduction of side effects would contribute to improve the quality of life and to decrease the frequency of disabling behavioural modifications in children, sometimes psychologically injured by hospital stay and postoperative pain.
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Affiliation(s)
- C Dadure
- Département d'anesthésie et de réanimation A, centre hospitalier universitaire Lapeyronie, 371, avenue du Doyen-Giraud, 34295 Montpellier, France
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Abstract
PURPOSE OF REVIEW More surgery on children is being carried out on a day-case basis and we review the anaesthetic management. Selection of appropriate patients and procedures is vital and careful preparation of children and families minimizes fear and anxiety and streamlines the organizational aspects of care. Simple, noninvasive general-anaesthetic techniques with modern agents are recommended. Good analgesia is important and is based upon local or regional blockade, nonsteroidal antiinflammatory drugs and paracetamol, with opioids being reserved for rescue analgesia. Omission of opioids helps to minimize postoperative emesis. Discharge home is facilitated by clear instructions about activities, dressings, wound care and continuing pain control. RECENT FINDINGS Oral clonidine premedication, new, safer local anaesthetic agents, ultrasound guidance for blocks and prolongation of single-injection caudal blocks with clonidine or ketamine are recent developments. Guidelines for safe sedation and analgesia for procedures are available. Behavioural and cognitive changes can be seen in children after anaesthesia and surgery and parents should be informed of this possibility. SUMMARY Children benefit particularly from day care and recent advances in anaesthesia and pain management have allowed a huge expansion of this modality of care with a consequent reduction in the need for children to be in hospital.
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Affiliation(s)
- Per-Arne Lonnqvist
- Department of Anaesthesia, Astrid Lindgrens Children's Hospital, Stockholm, Sweden.
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