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Continuous psoas compartment blocks after major orthopedic surgery in children: a prospective computed tomographic
1Departments of Anesthesia and Critical Care Medicine, Lapeyronie University Hospital, Montpellier, France. c-dadure@chu-montpellier.fr
Insights
Continuous psoas compartment blocks offer effective pain relief for children undergoing major lower limb orthopedic surgery. This technique provides excellent postoperative analgesia with minimal adverse events, enhancing patient recovery.
Area of Science:
- Pediatric Anesthesiology
- Orthopedic Surgery
- Pain Management
Background:
- Femoral shaft and hip surgeries in children are associated with significant postoperative pain.
- Effective pain management is crucial for optimal recovery and patient satisfaction.
Purpose of the Study:
- To define new computed tomographic (CT) landmarks for continuous psoas compartment blocks (CPCBs) in children.
- To evaluate the efficacy and safety of CPCB for postoperative pain relief after major orthopedic surgery in pediatric patients.
Main Methods:
- A preliminary CT scan study identified optimal puncture points for CPCB based on patient age and anatomy.
- A prospective clinical study administered CPCB with ropivacaine and lidocaine to 15 children undergoing femoral and hip osteotomies.
- Postoperative pain was assessed using validated scales, and adverse events were monitored.
Main Results:
- CPCBs were effective during surgery and provided excellent postoperative analgesia, with median pain scores of 1 at 1 hour and 0 from 6 hours onwards.
- Minimal motor blockade was observed before 24 hours, resolving thereafter.
- No major adverse events were reported, and 93% of parents reported satisfaction with the pain management.
Conclusions:
- Continuous psoas compartment blocks are a highly effective and safe method for managing postoperative pain in children after major proximal lower limb orthopedic surgery.
- The CT-derived landmarks for CPCB placement in this study were more medial than conventional anatomical references.
Unlabelled:
Femoral shaft or hip surgeries are very painful for children. We conducted both computed tomographic (CT) and clinical prospective studies to define new landmarks in children and to evaluate the effectiveness of continuous psoas compartment blocks (CPCBs) using disposable elastomeric pumps. In a preliminary CT scan study of 20 patients, the plexus depth was correlated to patient age and the optimal point of puncture for CPCB was three-quarters of the distance from the spinous process of L4 to a line parallel to the spinal column passing through the posterior superior iliac spine. In a subsequent prospective series, a CPCB was administered before surgery to 15 children for pain relief after femoral and hip osteotomies. After general anesthesia, a 0.5 mL/kg bolus of a mixture of 1% lidocaine with epinephrine (1/200.000) and 0.5% ropivacaine was injected through the CPCB catheter. After contrast media assessment of the catheter location, a disposable pump (Infusor LV); Baxter, Paris, France) with 0.2% ropivacaine was connected and pump flow was adjusted to the patient's weight (0.2 mg x kg(-1) x h(-1)). Postoperative pain was evaluated using a visual analog scale or the Children and Infants Postoperative Pain Score at hour H1, H6, H12, H18, H24, H36, and H48, and in terms of rescue analgesia, adverse events, and motor blocks. All blocks were effective during surgery. Postoperative analgesia was excellent. The median pain scores were 1 for H1 and 0 beginning H6. The motor blockade was minimal before 24 h and absent thereafter. No major adverse event was noted. Parents of 93% of the children were satisfied. We conclude that postoperative analgesia with CPCB is a very effective technique in children after major proximal lower limb orthopedic surgery. The CT scan landmarks described in this study were more medial than the conventional landmarks used in the literature.
Implications:
Continuous psoas compartment blocks provide optimal pain relief in children after major orthopedic surgery without major adverse events. The landmarks used, defined in a preliminary computed tomographic scan study, were more medial than conventional landmarks.
