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

Abstract

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.

What’s New in Pediatric Orthopaedics

“…This was associated with worse osteoarthritis radiographically, although pain scores were not collected in this study. However, another study compared lumbar plexus nerve blocks with epidurals or general anesthesia alone to determine which group of patients with GMFCS IV or V cerebral palsy used the least narcotics perioperatively 26 . Lumbar plexus blocks not only reduced cumulative narcotic consumption, but also decreased heart rate and length of hospital stay.…”

Regional anesthesia for hip surgery in children: A review

“…Результаты ретроспективного исследования A. Trionfo с соавт. [27] показали преимущество LPB при реконструкции тазобедренного сустава у детей с ДЦП. Сравнивали три группы пациентов, которые были разделены по виду анестезиологического обеспечения: LPB в сочетании с общей анестезией, ЭА в сочетании с общей анестезией и группа общей анестезии.…”