Epidural needle insertion

Bomberg, Hagen; Paquet, N.; Huth, Andrea; Wagenpfeil, Stefan; Kessler, Paul; Wulf, Hinnerk; Wiesmann, Thomas; Standl, Thomas; Gottschalk, André; Döffert, Jens; Hering, W.; Birnbaum, Jürgen; Kutter, B.; Winckelmann, Jörg; Liebl-Biereige, Simone; Meißner, Winfried; Vicent, O.; Koch, Thea; Bürkle, Hartmut; Sessler, Daniel I.; Raddatz, Alexander; Volk, Thomas

doi:10.1007/s00101-018-0499-1

Cited by 6 publications

(1 citation statement)

References 28 publications

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“…This may be attributed to a former hospital policy at our institution requiring that patients with epidurals be maintained in the intensive care unit for more acute monitoring given the possibility of hemodynamic changes. Although this protocol is no longer in place, it highlights the extra precautions required for epidurals due to the potential complications such as vascular or dural puncture, paresthesias, systemic local anesthetic toxicity, and epidural hematoma, 24 often which do not exist with peripheral nerve blocks, often which do not exist with peripheral nerve blocks. Although several factors outside the scope of this study may have contributed to LOS, there were no other systemic health-system changes to postoperative protocols during this time frame (eg, no changes in case management, physical therapy, etc).…”

Section: Discussionmentioning

confidence: 99%

Lumbar Plexus Nerve Blocks for Perioperative Pain Management in Cerebral Palsy Patients Undergoing Hip Reconstruction: More Effective Than General Anesthesia and Epidurals

Trionfo

Zimmerman

Gillock

et al. 2022

Journal of Pediatric Orthopaedics

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Background: Hip reconstruction in patients with cerebral palsy (CP) is associated with. significant postoperative pain. However, adequate analgesia can be difficult to achieve. in this population due to spasticity, communication barriers, and postoperative. spasticity. Recently, multimodal pain management techniques such as epidurals and. regional nerve blocks have been described for postoperative pain control, but it is unclear if 1 technique is more beneficial. The purpose of this study was to compare the outcomes of different perioperative pain management techniques. Methods: This study is a retrospective review of a consecutive series of children with CP over a 5-year period at a single pediatric tertiary-care hospital who underwent hip reconstruction (proximal femoral osteotomy with or without a pelvic osteotomy). Patients were subdivided based on their anesthetic protocol into the following groups: general anesthesia alone (G), general anesthesia with an epidural (E), and general anesthesia with lumbar plexus block (LPB). Our primary outcome was cumulative postoperative narcotic consumption (converted to morphine equivalents). Secondary outcomes included length of stay (LOS), average postoperative heart rate, and pain scores. analysis of variance testing was utilized to compare differences between the groups. Results: Fifty-four patients who underwent hip reconstruction were included: 19 in the G group, 18 in the E group, and 17 in the LPB group. LOS was significantly higher in the E group compared with the G and LPB groups: F(2,51)=3.58, P=0.04. The average pain score was significantly lower in the LPB group compared with the others: F(2,51)=4.26, P=0.02. The average postoperative heart rate was significantly lower in the LPB group: F(2,51)=7.08, P<0.01. Postoperative narcotic consumption was significantly lower in the LPB group: F(2,51)=11.57, P<0.01. Conclusion: The LPB patients required the least amount of narcotics compared with the other groups. This, combined with a lower perioperative heart rate and shorter LOS would suggest these patients experienced less pain over the time of their in-patient stay. In comparison to general anesthesia alone and epidural anesthesia, lumbar plexus nerve blocks are an effective pathway for postoperative pain control after hip reconstruction in a CP population. Level of Evidence: Level III—Case control or retrospective comparative study.

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Section: Discussionmentioning

confidence: 99%