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[Continuous epidural block versus continuous psoas compartment block for postoperative analgesia after major hip or
C Dadure1, S Bringuier, O Mathieu
1Service d'anesthésie réanimation A, centre hospitalier universitaire Lapeyronie, avenue du Doyen-Gaston-Giraud, Montpellier cedex 5, France. c-dadure@chu-montpellier.fr
Insights
Continuous psoas compartment block (CPCB) offers superior postoperative pain relief in children undergoing hip surgery compared to continuous epidural block (CEB). CPCB resulted in fewer adverse events and lower ropivacaine concentrations, making it a safer alternative for pediatric analgesia.
Area of Science:
- Pediatric Anesthesiology
- Regional Anesthesia Techniques
- Pain Management in Children
Background:
- Intravenous opioids and continuous epidural block (CEB) are common for pediatric hip surgery analgesia but have adverse effects.
- Continuous psoas compartment block (CPCB), effective in adults, presents a potential alternative for pediatric postoperative pain management.
Purpose of the Study:
- To compare the efficacy and safety of CPCB versus CEB in children undergoing major hip surgery.
- To evaluate postoperative pain relief, adverse events, and ropivacaine plasma concentrations between CPCB and CEB groups.
Main Methods:
- A randomized comparative study included 40 children (1-12 years) allocated to CPCB or CEB groups.
- Ropivacaine was administered via catheter post-anesthesia, with continuous infusions for 48 hours.
- Pain scores (VAS/CHIPPS), rescue analgesic use, adverse events, parent satisfaction, and ropivacaine plasma levels were assessed.
Main Results:
- Both CPCB and CEB provided excellent postoperative analgesia, with comparable rescue analgesic requirements.
- The CEB group experienced a significantly higher incidence of adverse events and premature block cessation.
- Ropivacaine plasma concentrations were significantly higher in the CEB group at 6 and 24 hours post-procedure.
Conclusions:
- Continuous psoas compartment block (CPCB) is an effective and safe method for pediatric postoperative analgesia after major hip surgery.
- CPCB demonstrates comparable pain management to CEB but with a significantly lower rate of adverse events and reduced ropivacaine exposure.
Background:
Intravenous opioids and/or continuous epidural block (CEB) are used for postoperative analgesia after hip and/or femoral shaft surgery but adverse effects limit their use in children. A continuous psoas compartment block (CPCB), effective technique in adults can be an alternative. In this randomized comparative study, we wanted to evaluate CEB and CPCB in children after major hip surgery in terms of adverse events, pain relief and ropivacaine plasma concentrations.
Methods:
After ethical committee and parents' approval, 40 children scheduled for hip surgery were included and randomly allocated to receive CPCB or CEB. After general anaesthesia induction, 0.5 mL/kg of 0.375% ropivacaine were injected via the epidural or lumbar plexus catheter. After surgery, 0.1 ml/kg per hour (group CPCB) or 0.2 ml/kg per hour (group CEB) of 0.2% ropivacaine was infused for 48h. Post-operative pain was evaluated using VAS or CHIPPS scores values at h1, h6, h12, h18, h24, h36 and h48, as well as doses of first line (paracetamol 15 mg/kg/6h) or second line rescue analgesia (0.2mg/kg intravenous nalbuphine), if pain score remained high after 30 mm. niflumic acid was systematically used. Adverse events were noted as well as parents' satisfaction at 48h. Ropivacaine plasma concentrations were measured four times up to 48h (h1, h6, h24 and h48) by high performance gas chromatography.
Results:
Forty children 1 to 12 years old (CPCB=20, CEB=20) were included. The demographic data were equivalent in both groups. Postoperative analgesia was excellent for both continuous block techniques during the whole studied period. Doses of rescue analgesics were comparable in both groups at the end of the 48h. Number of children who had at least one side effect is significantly higher in CEB group. Furthermore, the number of local anaesthetic premature stops was significantly more frequent in this group. Median values of ropivacaine plasma level in CEB group were significantly higher than CPCB group at h6 and h24. Ten parents in the CEB group and 15 in CPCB group were satisfied.
Conclusion:
Continuous psoas compartment block is an effective technique of postoperative analgesia after major hip or femoral surgery in children. It equally manages postoperative pain with significantly less adverse event and decreased ropivacaine doses and plasma concentration than CEB.
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