<p>Evaluation of postoperative analgesia in pediatric patients after hip surgery: lumbar plexus versus caudal epidural analgesia</p>

Abstract

Background: There continues to be focus on the value of regional and neuraxial anesthetic techniques when combined with general anesthesia to improve postoperative analgesia. The reported advantages include decreased postoperative opioid requirements, decreased medication-related adverse effects, decreased hospital length of stay, and increased patient satisfaction. Orthopedic procedures of the hip may be amenable to such techniques as there is significant postoperative pain with the requirement for hospital admission and the administration of parenteral opioids. Given the surgical site, various regional anesthetic techniques may be used to provide analgesia including caudal epidural anesthesia (CEA) or lumbar plexus blockade (LPB). Purpose: The objective of this study was to assess the effectiveness of LPB versus CEA as an analgesic thechnique for patients undergoing elective hip surgery from the opioid consumption and pain scores perspective. Patients and methods : The current study retrospectively reviews our experience with CEA and LPB for postoperative analgesia after hip surgery in the pediatric population. Regional anesthesia technique was reviewed as well as opioid requirements and pain scores. Results: The study cohort included 61 patients, 29 who received an LPB and 32 who received CEA. No difference was noted in the demographics between the two groups. Intraoperative opioid use was 0.7 (IQR: 0.5, 1.1) mg/kg of oral morphine equivalents (MEs) in the LPB group compared to 0.6 (IQR: 0.5, 0.9) in the CEA group ( p =0.479). Postoperative opioid use over the first 48 hrs was 4 (IQR: 1, 6) mg/kg of oral ME in the LPB group, compared to 2 (interquartile range [IQR]: 1, 3) in the CEA group ( p =0.103). Over the first 24 hrs after surgery, the median pain score in the LPB group was 5 (IQR: 1–6), compared to 3 (IQR: 0, 5) in the CEA group ( p =0.014). Conclusion: These retrospective data suggest a modest postoperative benefit of CEA when compared to LPB following hip surgery in the pediatric population. Postoperative pain scores were lower in patients receiving CEA; however, no difference in the intraoperative or postoperative opioid requirements was noted between the two groups.

Utilization of a Continuous Pericapsular Nerve Group (PENG) Block with an Opioid-Sparing Repair of a Femoral Neck Fracture in a Pediatric Patient

“…Cannulated screw fixation is usually required for older children in whom transcervical fracture is unstable, and the determination of open versus closed approach commonly depends on the success of surgical traction for reduction. Regional anesthetic techniques are safe in children [14][15][16] and can provide analgesia for pediatric patients undergoing hip surgery [3][4][5][6]. Adequate analgesia results in faster rehabilitation, decreased opioid consumption, and avoidance of the untoward side effects associated with opioids.…”

“…As such, regional anesthesia is advantageous in providing sufficient analgesia while reducing the adverse effects of opioids. Lumbar plexus blockade, neuraxial techniques (caudal or epidural), and combined femoral nerve and fascia iliaca blockade have been shown in a myriad of pediatric studies to exhibit opioid-sparing effects and lower postoperative pain scores in patients who are suffering from hip pain [3][4][5][6].…”

“…Despite the success of neuraxial techniques in decreasing postoperative pain scores in pediatric patients undergoing hip surgery [ 4 – 6 ], positioning requirements, bilateral sensory and motor blockade, and urinary retention limit their use. Our institutional practice includes administration of a general anesthetic combined with a lumbar plexus continuous nerve block for children undergoing unilateral hip surgery.…”

Short Communication: Lumbar Plexus Block versus Suprainguinal Fascia Iliaca Block to Provide Analgesia Following Hip and Femur Surgery in Pediatric-Aged Patients – An Analysis of a Case Series

“… 9 , 10 , 17 Additionally, spread of the local anesthetic agent into the epidural space may result in bilateral lower extremity blockade. 8 , 13 , 19 , 20 Ultrasound-guided suprainguinal FICB has been shown to provide effective postoperative analgesia for total hip arthroplasty. 15 , 21 The superficial approach makes the procedure relatively easier, the block can be placed with the patient positioned supine, and with use of ultrasound-guidance the potential for adverse effects is limited.…”

“…[1][2][3][4] With advances in pediatric regional techniques, neuraxial blocks are being replaced with peripheral nerve blockade such as lumbar plexus block (LPB) to achieve a selective unilateral blockade for procedures involving the hip and thigh. [5][6][7][8] However, placement of a LPB requires lateral or prone positioning and a deep needle trajectory to contact the lumbar plexus in the paravertebral space, which may be associated with complications such as needle advancement into the peritoneum, retroperitoneal hematoma, and renal injury. Occasional local anesthetic spread into the epidural space may also negate some of the benefits of selective peripheral nerve blockade.…”