Regional anesthetic techniques for hip surgery in children with cerebral palsy

Patients with cerebral palsy (CP) experience pain through the lifespan. The hip joint is the main source of nociceptive input. Use of nonopioid adjuvant medication and regional anesthesia for hip surgeries can be an integral part of a perioperative strategy to decrease opioid use. Regional anesthes...

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Main Authors: Vadim V. Evreinov, Tatyana A. Zhirova
Format: Article
Language:English
Published: Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics 2020-12-01
Series:Гений oртопедии
Subjects:
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spelling doaj-dad751d9bfe0452c858c5283637f76842020-12-22T04:39:15ZengRussian Ilizarov Scientific Center for Restorative Traumatology and OrthopaedicsГений oртопедии1028-44272542-131X2020-12-0126452152610.18019/1028-4427-2020-26-4-521-526Regional anesthetic techniques for hip surgery in children with cerebral palsyVadim V. Evreinov0Tatyana A. Zhirova1Ilizarov National Medical Research Centre for Orthopaedics and Traumatology, Kurgan, Russian FederationIlizarov National Medical Research Centre for Orthopaedics and Traumatology, Kurgan, Russian FederationPatients with cerebral palsy (CP) experience pain through the lifespan. The hip joint is the main source of nociceptive input. Use of nonopioid adjuvant medication and regional anesthesia for hip surgeries can be an integral part of a perioperative strategy to decrease opioid use. Regional anesthesia can be delivered efficiently and safely for pediatric orthopedic patients. Objective To compare different regional anesthetic techniques used for multi-level lower limb orthopedic surgeries in children with moderate and severe CP. Material and methods A prospective randomized comparative clinical trial enrolled 101 CP patients who underwent unilateral multi-level lower limb surgery for spastic hip displacement or subluxation. According to a type of anesthesia used, patients were allocated into 3 groups: patients receiving prolonged epidural analgesia (PEA) and fentanyl for sedation (PEAF, n = 32); patients receiving PEA and benzodiazepine for sedation (PEAB, n = 37), and patients receiving a continuous femoral plus single-shot sciatic nerve block and benzodiazepines for sedation (FSNBB, n = 32). Hemodynamic findings, pain intensity, a need for opioids and additives (NSAIDs), the level of sedation and complication rate were evaluated. Results The use of NSAIDs (paracetamol) was significantly higher in PEAB and FSNBB groups as compared to PEAF patients with fentanyl administered, and there were no statistically significant differences in the level of pain recorded with the r-FLACC score among the study groups. There were no statistically significant differences in the level of sedation and agitation measured with the Ramsay Sedation Scale and Richmond Agitation-Sedation Scale (RASS) among the groups at early postoperative period. Apnoea as a complication was observed in a PEAF patient. Conclusion A continuous femoral plus single-shot sciatic nerve block and PEA added with NSAIDs (paracetamol) and benzodiazepines for sedation have shown the comparative effectiveness and safety for a perioperative analgesia of CP patients undergoing multi-level lower limb surgeries as compared to the use of PEA and fentanyl for sedation.cerebral palsychildhoodcontinuous femoral nerve blockprolonged epidural analgesiahip surgery
collection DOAJ
language English
format Article
sources DOAJ
author Vadim V. Evreinov
Tatyana A. Zhirova
spellingShingle Vadim V. Evreinov
Tatyana A. Zhirova
Regional anesthetic techniques for hip surgery in children with cerebral palsy
Гений oртопедии
cerebral palsy
childhood
continuous femoral nerve block
prolonged epidural analgesia
hip surgery
author_facet Vadim V. Evreinov
Tatyana A. Zhirova
author_sort Vadim V. Evreinov
title Regional anesthetic techniques for hip surgery in children with cerebral palsy
title_short Regional anesthetic techniques for hip surgery in children with cerebral palsy
title_full Regional anesthetic techniques for hip surgery in children with cerebral palsy
title_fullStr Regional anesthetic techniques for hip surgery in children with cerebral palsy
title_full_unstemmed Regional anesthetic techniques for hip surgery in children with cerebral palsy
title_sort regional anesthetic techniques for hip surgery in children with cerebral palsy
publisher Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics
series Гений oртопедии
issn 1028-4427
2542-131X
publishDate 2020-12-01
description Patients with cerebral palsy (CP) experience pain through the lifespan. The hip joint is the main source of nociceptive input. Use of nonopioid adjuvant medication and regional anesthesia for hip surgeries can be an integral part of a perioperative strategy to decrease opioid use. Regional anesthesia can be delivered efficiently and safely for pediatric orthopedic patients. Objective To compare different regional anesthetic techniques used for multi-level lower limb orthopedic surgeries in children with moderate and severe CP. Material and methods A prospective randomized comparative clinical trial enrolled 101 CP patients who underwent unilateral multi-level lower limb surgery for spastic hip displacement or subluxation. According to a type of anesthesia used, patients were allocated into 3 groups: patients receiving prolonged epidural analgesia (PEA) and fentanyl for sedation (PEAF, n = 32); patients receiving PEA and benzodiazepine for sedation (PEAB, n = 37), and patients receiving a continuous femoral plus single-shot sciatic nerve block and benzodiazepines for sedation (FSNBB, n = 32). Hemodynamic findings, pain intensity, a need for opioids and additives (NSAIDs), the level of sedation and complication rate were evaluated. Results The use of NSAIDs (paracetamol) was significantly higher in PEAB and FSNBB groups as compared to PEAF patients with fentanyl administered, and there were no statistically significant differences in the level of pain recorded with the r-FLACC score among the study groups. There were no statistically significant differences in the level of sedation and agitation measured with the Ramsay Sedation Scale and Richmond Agitation-Sedation Scale (RASS) among the groups at early postoperative period. Apnoea as a complication was observed in a PEAF patient. Conclusion A continuous femoral plus single-shot sciatic nerve block and PEA added with NSAIDs (paracetamol) and benzodiazepines for sedation have shown the comparative effectiveness and safety for a perioperative analgesia of CP patients undergoing multi-level lower limb surgeries as compared to the use of PEA and fentanyl for sedation.
topic cerebral palsy
childhood
continuous femoral nerve block
prolonged epidural analgesia
hip surgery
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