Unexplained fever after bilateral superficial cervical block in children undergoing cochlear implantation: an observational study

Abstract

Purpose In an effort to decrease postoperative opioid requirements, intraoperative bilateral superficial cervical plexus block (BSCPB) was recently adopted for all our children undergoing general anesthesia for bilateral simultaneous cochlear implantation (BSiCI). Several cases of early postoperative fever were noted after the adoption of BSCPB. Our aim was to determine if an association exists between BSCPB and early postoperative fever in children undergoing BSiCI. As a secondary outcome, we studied the efficacy of BSCPB in altering postoperative analgesic requirements. Methods We conducted a retrospective cohort study of 91 consecutive children who underwent BSiCI. The series included 34 patients who received BSCPB (Block Group) and 57 patients who did not receive BSCPB (No-block Group). Results The median age (range) was 15.4 months (eight months -15 yr). A significant association was found between BSCPB and postoperative fever (P = 0.006). Eighteen (19.7%) children developed fever in the first 24 hr after surgery (Block Group: 12/34 [35%]; No-block Group: 6/57 [11%]; P = 0.006). The Block Group was 4.8 times more likely to develop early postoperative fever after adjusting for other variables (P = 0.004). The Block Group spent more days in hospital after surgery compared with the No-block Group (P = 0.043). Other vital signs showed no major deviation from the normal ranges, and daily physical examinations revealed no obvious source of infection in children who developed postoperative fever. Conclusion Bilateral superficial cervical plexus block may increase the risk of postoperative fever in children undergoing BSiCI. In this series, BSCPB was associated with a longer hospital admission. The etiology of the fever is undetermined, although it can be hypothesized that BSCPB resulted in unintended block of the phrenic nerves leading to diaphragmatic paralysis, atelectasis, and early postoperative fever in young children. RésuméObjectif Dans un effort visant a`diminuer les besoins postope´ratoires en morphiniques, le bloc bilate´ral perope´ratoire du plexus cervical superficiel (BSCPB) a e´teŕ e´cemment adopte´pour tous les enfants ayant une anesthe´sie ge´ne´rale pour implantation cochle´aire bilate´rale simultane´e (BSiCI). Plusieurs cas de fie`vre postope´ratoire pre´coce ont e´teć onstate´s apre`s l'adoption du BSCPB. Notre but e´tait de de´terminer s'il existe une association entre le BSCPB et la fie`vre postope´ratoire pre´coce chez des enfants subissant une BSiCI. Nous avons e´galement e´tudie´comme crite`re d'e´valuation secondaire l'efficacite´du BSCPB a`modifier les besoins en analge´siques postope´ratoires. Méthodes Nous avons mene´une e´tude de cohorte re´trospective sur 91 enfants conse´cutifs subissant une BSiCI. La se´rie a inclus 34 patients qui avaient eu un

Effects of Unilateral Intermediate Cervical Plexus Block on the Diaphragmatic Function in Patients Undergoing Unilateral Thyroidectomy: A Randomized Controlled Study

“…Several studies using 0.5% or higher concentrations of ropivacaine also suggest that the prevertebral fascia can be permeated. 8,9,[18][19][20] There are also clinical studies suggesting that the prevertebral fascia is impermeable, and these studies have lower concentrations of LAs. 4,7,21,22 So far, there was no study involving long-term observation of diaphragmatic excursion more than 1h after ICPB.…”

“…5,6 Previous clinical studies have used the presence of Horner syndrome, dyspnea and atelectasis to predict whether LAs could penetrate the prevertebral fascia after ICPB; however, these methods had drawbacks such as low sensitivity and thus the result is unreliable. [7][8][9] At present, the diaphragm ultrasound has been used to identify the changes in diaphragm function after ICPB. 10,11 It is noteworthy that the concentration of LAs used and the diagnostic criteria for diaphragmatic dysfunction were different among different studies on the effect of ICPB on diaphragm function, leading to conflicting conclusions.…”

Cervical plexus block

“…Studies by Barone et al [ 85 ], Ramachandran et al [ 8 ], and Merdad et al [ 83 ] used a blind approach for the intermediate CPB targeting the space between investing fascia and prevertebral fascia by using landmarks and loss of resistance or pop technique, although Merdad et al [ 83 ] used the term “superficial” CPB instead of “intermediate” CPB. Nonetheless, it was probably not easy even for very experienced practitioners to place the needle tip precisely at the desired space without the aid of ultrasonography.…”

Anesthetic Management of a Patient Undergoing Cochlear Implantation With Superficial Cervical Plexus Block and Sedation: A Case Report

“…12 Bilateral cochlear implants with general anesthesia and a SCPB have been reported. 13 However, to our knowledge, there are no case reports of anesthetic management with a SCPB and sedation for cochlear implantation.…”