Psoas Compartment Block for Acute Postoperative Pain Management After Hip Surgery in Pediatrics

Omar, Ahmed M.; Mansour, M. A.; Kamal, Adil S

doi:10.1097/aap.0b013e31820d41f3

Cited by 12 publications

(9 citation statements)

References 18 publications

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“…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 – 16 ] and can provide analgesia for pediatric patients undergoing hip surgery [ 3 – 6 ]. Adequate analgesia results in faster rehabilitation, decreased opioid consumption, and avoidance of the untoward side effects associated with opioids.…”

Section: Discussionmentioning

confidence: 99%

“…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 – 6 ].…”

Section: Introductionmentioning

confidence: 99%

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

Wyatt

Zidane

Liu

2020

Case Reports in Orthopedics

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In the pediatric population, femoral neck fractures are usually associated with high-impact trauma and often present with pain in the groin area. Regional anesthesia can offer adjunctive therapy for acute pain management. Various techniques have been employed to circumvent pain related to hip fractures and resultant hip surgery. Neuraxial, lumbar plexus, caudal, epidural, fascia iliaca, and femoral continuous nerve block techniques are advantageous in mitigating hip pain. However, these approaches require patient repositioning during placement and carry the potential for motor blockade with resultant weakness. A newly described method, the Pericapsular Nerve Group (PENG) block, allows for analgesia of the anterior hip capsule via the obturator, accessory obturator, and femoral nerves while sparing motor blockade. PENG blockade has demonstrated efficacy in both adult and pediatric patients. Herein, we describe the perioperative course of a 9-year-old girl with a transcervical femoral neck fracture who underwent an opioid-sparing open repair with the utilization of a continuous PENG block. PENG blockade via a continuous nerve block resulted in optimal analgesia and markedly reduced perioperative opioid consumption with preserved motor function. Our experience facilitated early discharge and rehabilitation mobility while reducing potential rebound hyperalgesia and enabling parental/patient satisfaction.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Wyatt

Zidane

Liu

2020

Case Reports in Orthopedics

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“…Only one study examined a regional anaesthesia technique in children for hip or pelvic surgeries. 42 Omar and colleagues 42 compared postoperative analgesic effects of psoas compartment block vs a caudal block in paediatric patients undergoing hip reduction/osteotomies. They found that the children in the caudal group used more morphine in 24 h after operation and needed rescue analgesia sooner than the psoas compartment block group.…”

Section: Hip and Pelvismentioning

confidence: 99%

Regional anaesthesia to improve pain outcomes in paediatric surgical patients: a qualitative systematic review of randomized controlled trials

Suresh

Schaldenbrand

Wallis

et al. 2014

British Journal of Anaesthesia

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Summary The development of analgesic interventions in paediatric surgical patients is often limited by the inherent difficulties of conducting large randomized clinical trials to test interventions in those patients. Regional anaesthesia is a valid strategy to improve postoperative pain in the adult surgical population, but the effects of regional anaesthesia on postoperative pain outcomes in paediatric patients are currently not well defined. The main objective of the current review was to systematically evaluate the use of regional anaesthesia techniques to minimize postoperative pain in paediatric patients. A systematic search was performed to identify randomized controlled trials that evaluated the effects of the regional anaesthesia techniques on postoperative pain outcomes in paediatric surgical patients' procedures. Seventy-three studies on 5125 paediatric patients were evaluated. Only few surgical procedures had more than one small randomized controlled trial favouring the use of regional anaesthesia to minimize postoperative pain (ophthalmological surgery, cleft lip repair, inguinal hernia, and urological procedures). Additional evidence is required to support the use of specific regional anaesthesia techniques to improve postoperative pain for several surgical procedures (craniectomy, adenotonsillectomy, appendectomy, cardiac surgery, umbilical hernia repair, upper and lower extremity) in paediatric patients. Currently, only a very limited number of regional anaesthesia techniques have demonstrated significant improvement on postoperative pain outcomes for a restricted number of surgical procedures. More studies are needed in order to establish regional anaesthesia as a valid strategy to improve analgesia in the paediatric surgical population.

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“…In congenital club foot surgery, a comparison of single-shot caudal anesthesia with single-shot peripheral nerve blocks (combined sciatic femoral, combined sciatic saphenous, and saphenous combined with local infiltration) showed no difference in the duration of analgesia and no difference in morphine consumption within the first 24 h, there was no difference in the incidence of nausea and vomiting between any of the groups (301). Single-shot Psoas Compartment Block showed moderate reduction in postoperative opioid requirements compared to caudal epidural following open hip reduction or osteotomy (302).…”

Section: Epidural Vs Peripheral Nerve Blockmentioning

confidence: 94%

Good Practice in Postoperative and Procedural Pain Management, 2nd Edition

2012

Pediatric Anesthesia

122

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Pe d iatric Ane sth e sia is ind e xe d in Ind e x Me d icus, MEDLINE, Curre nt Co nte nts/Clinical Me d icine , EMBASE/ Exce rp ta Me d ica, Sci Se arch , Re se arch Ale rt, Ad Re f e re nd um Anae sth e sio lo gy, SUBIS and Curre nt Op inio n in Anae sth e sio lo gy Pediatric Anesthesia Volume 22 Supplement 1 July 2012 that the relationship is causal 2+ Well-conducted case-control or cohort studies with a low risk of confounding, bias, or chance and a moderate probability that the relationship is causal 2) Case-control or cohort studies with a high risk of confounding, bias, or chance and a significant risk that the relationship is not causal 3 Non-analytic studies, e.g. case reports, case series 4 Expert opinion 2

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Psoas Compartment Block for Acute Postoperative Pain Management After Hip Surgery in Pediatrics

Abstract: Use of single-shot PCB is superior to single-shot caudal block regarding length of postoperative analgesia and cumulative dose of morphine in small children undergoing open hip reduction/osteotomies.

Cited by 12 publications

References 18 publications

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

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

Regional anaesthesia to improve pain outcomes in paediatric surgical patients: a qualitative systematic review of randomized controlled trials

Good Practice in Postoperative and Procedural Pain Management, 2nd Edition

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