Continuous peripheral nerve blockade for inpatient and outpatient postoperative analgesia in children

Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104-4399, USA.
Anesthesia and analgesia (Impact Factor: 3.42). 11/2007; 105(5):1234-42, table of contents. DOI: 10.1213/01.ane.0000284670.17412.b6
Source: PubMed

ABSTRACT This is an audit of the continuous peripheral nerve blockade (CPNB) program that was implemented at our institution to provide postoperative analgesia after orthopedic procedures in children.
We reviewed the departmental regional anesthesia registry and the medical records of consecutive children who received CPNB for postoperative analgesia at The Children's Hospital of Philadelphia between February 2003 and July 2006. Patients were prospectively followed until cessation of the effects of CPNB and/or resolution of any related complications. Data collected contemporaneously included presence of sensory and motor blockade, pain scores in inpatients, opioid administration, and complications related to CPNB.
A total of 226 peripheral nerve catheters were placed in 217 patients. One hundred eight patients (112 catheters) were discharged home with CPNB. The ages ranged from 4 to 18 yr (13.7 +/- 3.4). Local anesthetic solution (0.125% bupivacaine [n = 164], 0.1% ropivacaine [n = 12], or 0.15% ropivacaine [n = 27]) was infused at an initial rate of 2-12 mL/h based on patients' weights and locations of catheters. The mean duration of local anesthetic infusion was 48.4 +/- 29.3 h (range 0-160 h). The percentage of patients who did not require any opioids in the first 8, 24, and 48 h after surgery was 56%, 26%, and 21%, respectively. The incidence of nausea and vomiting was 14% (13% in outpatients, 15% in inpatients). Complications were noted in 2.8% of patients. Three patients had prolonged numbness (>24 h) that resolved spontaneously; one developed superficial cellulitis that resolved with a course of antibiotics; one had difficulty removing the catheter at home and one developed tinnitus 24 h after starting CPNB that resolved quickly after clamping of the catheter followed by removal.
It is feasible to implement a CPNB program to provide an alternative method of inpatient and outpatient postoperative analgesia after orthopedic surgery in children when appropriate expertise is available. Patient and family education along with frequent follow-up are crucial to detect and address adverse events promptly.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Outpatient pain management after iliac crest bone harvesting can be challenging. We report the use of home L2 paravertebral nerve block catheter (L2PVBC) in a series of five children. The pain scores were low, and analgesic medication consumption was minimal. No complications were reported related with these catheters, and the patients reported very high pain control satisfaction scores. Outpatient L2PVBC can be beneficial as part of a multimodal analgesia strategy in selected pediatric patients.
    Pediatric Anesthesia 05/2014; 24(8). DOI:10.1111/pan.12427 · 1.74 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Continuous peripheral nerve blocks (CPNB) are commonly used for intraoperative and postoperative analgesia. Our study aimed at describing our experience with ambulatory peripheral nerve catheters. After Institutional Review Board approval, records for all patients discharged with supraclavicular or popliteal catheters between January 1, 2009 and December 31, 2011 were reviewed. A licensed practitioner provided verbal and written instructions to the patients prior to discharge. Daily follow-up phone calls were conducted. Patients either removed their catheters at home with real-time simultaneous telephone guidance by a member of the Acute Pain Service or had them removed by the surgeon during a regular office visit. The primary outcome of this analysis was the incidence of complications, categorized as pharmacologic, infectious, or other. The secondary outcome measure was the average daily pain score. Our study included a total of 1059 patients with ambulatory catheters (769 supraclavicular, 290 popliteal). The median infusion duration was 5 days for both groups. Forty-two possible complications were identified: 13 infectious, 23 pharmacologic, and 6 labeled as other. Two patients had retained catheters, 2 had catheter leakage, and 2 had shortness of breath. Our study showed that prolonged use of ambulatory catheters for a median period of 5 days did not lead to an increased incidence of complications.
    04/2014; 2014:572507. DOI:10.1155/2014/572507
  • [Show abstract] [Hide abstract]
    ABSTRACT: Regional anesthesia should be used for children whenever possible and is an essential element of a multimodal pain management. The prerequisites for a safe and effective procedure are detailed knowledge of the anatomical, physiological and pharmacological differences in childhood, the use of age-appropriate equipment and rapid recognition and treatment of possible complications. Extensive experience in pediatric as well as regional anesthesia is essential. The rule for selection of the ideal regional anesthesia procedure for each individual patient is: as central as necessary and as peripheral as possible. A risk-benefit assessment must always be carried out. Very specialized techniques, such as thoracic and lumbar epidural anesthesia in childhood must be reserved for specialist pediatric anesthesia centers because experience is necessary which can only be acquired and maintained from a large number of cases. Technically simple procedures, such as caudal anesthesia, penis root block and wound infiltration are, however, also very effective. Even if the evidence is still lacking, ultrasound-guided placement of regional anesthesia is nowadays the method of choice for children. The use will lead to an increased level of acceptance and user-friendliness of the procedure in childhood. This article presents recommendations which demonstrate those points that must be generally observed when carrying out regional anesthesia in children. An overview of the regional anesthesia procedure in children is given.
    Der Schmerz 02/2014; 28(1):67-81. DOI:10.1007/s00482-013-1386-y · 1.50 Impact Factor

Full-text (2 Sources)

Available from
May 29, 2014