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Safety of pediatric continuous interscalene block catheters placed under general anesthesia: a single center's
H Gurnaney1, W T Muhly, F W Kraemer
1Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Insights
Placing interscalene catheters under general anesthesia for pediatric shoulder surgery is feasible. This approach allows for outpatient management with a high success rate and few complications.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Regional Anesthesia
Background:
- Interscalene catheters are effective for pediatric shoulder surgery pain management.
- Placing catheters in awake children is challenging.
- Concerns exist regarding regional anesthesia in anesthetized pediatric patients.
Purpose of the Study:
- To evaluate the feasibility and safety of interscalene catheter placement under general anesthesia in pediatric patients.
- To assess outpatient management of these catheters.
Main Methods:
- A case series of 154 interscalene catheters placed in pediatric patients under general anesthesia using a modified lateral approach.
- Patients were managed in an outpatient setting with daily follow-up phone calls.
Main Results:
- 132 (85.7%) patients were discharged home with the catheter.
- The overall success rate was 92.1%.
- The most common failure was early dislodgement (6%); 3 additional patients experienced adverse events.
Conclusions:
- Interscalene catheter placement under general anesthesia is a feasible option for pediatric patients.
- Outpatient management of these catheters is safe and effective.
- This technique is associated with a low rate of catheter-related complications.
Background:
The use of interscalene catheters is an effective treatment strategy for children and adolescents undergoing shoulder surgery. Although placement of interscalene catheters in the awake child is challenging, some have cautioned against performing regional anesthesia in the patient under general anesthesia. We present a case series of 154 interscalene catheters placed in pediatric patients under general anesthesia and managed in the outpatient setting.
Methods:
A total of 154 interscalene catheters were placed at a single institution between April 2006 and December 2011 using a modified lateral approach. All catheters were placed with the patient under general anesthesia. The patients discharged home with the catheters were followed-up with daily phone calls until removal of the catheter.
Results:
Of the 154 patients with an interscalene CPNB, 132 (85.7%) were discharged home with the interscalene CPNB in place. The success rate for the catheters was 92.1% (CI: 86.9-95.7%). The most common reason for catheter failure (6%) was early dislodgement (within 24 h). In addition to these 12 patients, 3 other patients had adverse events related to the interscalene CPNB.
Conclusion:
Interscalene catheter placement under general anesthesia and management on an outpatient basis is feasible in the pediatric population and is associated with a low rate of catheter-related complications.
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