Continuous peripheral nerve blocks for postoperative analgesia in children: feasibility and side effects in a cohort study of 339 catheters

Abstract

Introduction Perioperative continuous peripheral nerve blocks (CPNB) are increasingly being used in children. Only one previous study has reported adverse events of CPNB in a high number of pediatric cases. We evaluated the indications, block efficacy, and adverse events related to CPNB in children. Methods All CPNBs that were performed in children for postoperative analgesia over a 5-year period at the Montpellier University Hospital in France were included in this study. The first bolus dose and the continuous doses of local anesthetic were not standardized. In the postoperative period, demographic data, quality of analgesia, amount of rescue analgesic medication, child/parent satisfaction, and adverse events were recorded in our Departmental Regional Anesthesia registry. Results A total of 339 catheters were evaluated in 292 children ASA physical status I to III. The median age was 8 yr (0.6-17 yr) and the median weight was 28 kg (7-116 kg). The main surgical indications were hip, femoral, or tibial osteotomies (44.5%) and club foot repair (27.4%). The local anesthetics used were either bupivacaine or ropivacaine. The mean volume of the local anesthetic bolus dose was 0.49 ± 0.16 mL Á kg -1 , and the mean regimen of local anesthetic continuous infusion was 0.11 ± 0.04 mL Á kg -1 Á hr -1 . The median duration of CPNB was 61.6 hr (range 0-264 hr). Pain relief, which was evaluated with the children at rest, was considered optimal in the majority of patients throughout the study period. The Children and Infants Postoperative Pain Scale (CHIPPS) was used in children age 0-6 yr and the Visual Analog Pain Scale (VAS) was used in children 7 yr and older. There were no major adverse events. There were 211 minor adverse events recorded in 153 CPNBs (45.1%). The most frequently reported complication (20.1%) involved mechanical problems with the catheter, followed by nausea and vomiting (14.7%). Conclusion CPNBs are indicated after orthopedic surgery in children. Our results demonstrate that CPNBs are feasible in the pediatric setting, and in skilled hands, they promote prolonged analgesia in the majority of patients without major adverse events. The most common minor adverse events are catheter-related mechanical problems and postoperative nausea and vomiting.

Pudendal Versus Caudal Block in Children Undergoing Hypospadias Surgery

“…5,6 Cohort analyses support this view and suggest a higher benefit-to-risks ratio for peripheral blocks. 5,19 One of the most important adverse effects of both central and peripheral blocks is motor block and sphincter functional dysfunction. No adverse effects or motor blocks were found in the caudal or pudendal groups postoperatively.…”

Home peripheral nerve catheters: the first 24 months of experience at a children’s hospital

“…Ganesh et al2 experienced leakage in five (2.3%) patients, and this was the cause of early removal in one of them. Other studies have demonstrated accidental catheter removal in 15%7 and 10.5%8 of patients. To help decrease the incidence of catheter leakage, we typically occlude the catheter insertion site with a small drop of Dermabond™ to seal the site.…”

Long-Term Use of Nerve Block Catheters in Paediatric Patients with Cancer Related Pathologic Fractures

“…Their potential benefits include earlier ambulation, improved outpatient pain management, fewer complications and reduced opioid-related side-effects 9 . Although the safety and efficacy of CNBs including outpatient use 10 has been reported in paediatric patients 8 , most reports pertain to their use for postoperative pain control 7,8,10,11 . There are limited reports on the use of this technique for other indications in children 12,13 , including the use of long-term CNB catheters for palliative pain control at the end of life 14 .…”