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Are peripheral nerve blocks effective in pain control of pediatric orthopedic tumor surgery?
Güldeniz Argun1, Göze Çayırlı, Güray Toğral
1Department of Anesthesiology and Reanimation, University of Health Sciences, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, 06200 Yenimahalle, Ankara, Turkey.
Insights
Ultrasound-guided peripheral nerve blocks provide extended pain relief for pediatric orthopedic tumor surgery patients, significantly delaying pain onset and reducing overall analgesic needs compared to intravenous methods.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Pain Management
Background:
- Effective postoperative pain management is crucial for pediatric patients undergoing orthopedic tumor surgery.
- Traditional intravenous analgesia may be associated with significant side effects and limited efficacy.
- Ultrasound-guided peripheral nerve blocks offer a targeted approach to regional anesthesia.
Purpose of the Study:
- To evaluate the efficacy of ultrasound (US)-guided peripheral nerve blocks for postoperative analgesia in children.
- To compare nerve blocks with intravenous analgesia in terms of pain scores, time to pain onset, and analgesic consumption.
- To assess the incidence of nausea, vomiting, and other complications associated with each method.
Main Methods:
- A retrospective study of 108 pediatric patients (2-18 years) who underwent orthopedic tumor surgery.
- Patients were divided into two groups: US-guided peripheral nerve block (n=54) or intravenous analgesic (n=54).
- Postoperative outcomes including Visual Analog Scale (VAS) scores, time to pain onset, and analgesic use were recorded at multiple time points.
Main Results:
- Nerve block group showed significantly lower VAS scores at 1, 2, and 6 hours post-surgery.
- Mean time to pain onset was substantially longer in the nerve block group (10.2 hours) compared to the intravenous group (1.8 hours).
- Total 24-hour analgesic consumption was significantly reduced in the nerve block group.
Conclusions:
- Ultrasound-guided peripheral nerve blocks provide effective and prolonged postoperative analgesia in pediatric orthopedic tumor surgery.
- This technique may enhance patient recovery by minimizing pain and reducing the need for systemic analgesics and their associated side effects.
- Nerve blocks offer a valuable alternative for managing acute postoperative pain in this patient population.
Objectives:
This study aims to evaluate the efficacy of ultrasound (US)-guided peripheral nerve blocks in postoperative analgesia after pediatric orthopedic tumor surgery.
Patients And Methods:
This retrospective study included 108 children (64 boys, 44 girls, mean age 10.23 years; range, 2 to 18 years) who were performed orthopedic tumor surgery under general anesthesia. The children were divided into two groups as those who were performed nerve block for postoperative pain control (group 1, n=54) and those who were performed intravenous analgesic (group 2, n=54). In group 1, nerve blocks were performed with bupivacaine 0.25%. In group 2, intraoperative acetaminophen 15 mg/kg was performed intravenously. Postoperative visual analog scale (VAS) scores, time to pain onset, nausea, vomiting, total analgesic consumption in 24 hours, and complications were recorded at first, second, sixth and 24th hours.
Results:
Visual analog scale scores were higher in group 2 than group 1 at first, second, and sixth hours, but were not different at 24th hour. Mean time to pain onset was 10.2 hours in group 1 and 1.8 hours in group 2 (p<0.05). Mean time to pain onset and VAS values at first, second, sixth and 24th hours did not differ between nerve block types. Nausea and vomiting rates were not different between groups 1 and 2 (18.51% and 16.66%, respectively; p=0.4). Total analgesic consumption in 24 hours was higher in group 2 compared to group 1 (1.7 and 0.07 mg/kg, respectively; p<0.05).
Conclusion:
Pain-free periods extending up to 10 hours provided by US-guided peripheral nerve blocks may help recovery while reducing postoperative analgesic use and their side effects.
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