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Microtia Reconstruction and Erector Spinae Block in Children: A Case Series With Chart Review
Gabriel Gomez1, Beth Osterbauer1, Robert Nguyen2
1Division of Otolaryngology-Head and Neck Surgery, Children's Hospital Los Angeles, Los Angeles, California, USA.
Objectives:
Autologous reconstruction of microtia is advantageous due to its inherent biocompatibility and long-term stability, but postoperative pain associated with costal harvest is a significant issue. A well-planned pain management approach is imperative. Our objective is to introduce the novel application of erector spinae block anesthesia in pediatric microtia reconstruction and evaluate its impact on pain scores, use of opioids, and hospital length of stay.
Study Design:
Case series with chart review.
Setting:
Patients undergoing stage 1 microtia reconstruction at a tertiary pediatric hospital.
Methods:
Data collected included demographics, opioid amounts, Wong-Baker FACES Pain Rating Scale scores, opioid-related side effects, and hospital length of stay. We used generalized estimating equations to examine the effect of erector spinae block use on total opioid use and pain scores and a linear regression model to assess the effect on hospital stay.
Results:
Forty-seven patients were included: 14 in the erector spinae block group and 33 in the continuous wound pump group. The mean age was 8.3 years (SD, 2; range, 6-13), and 13 (32%) were female. Patients in the erector spinae block group had a 65.44% decrease in adjusted total opioid use (95% CI, -79.72% to -41.10%; P < .0001), a decrease in length of hospital stay (β = -1.69 [95% CI, -2.11 to -1.26], P < .0001), and no difference in reported pain scores when compared with patients in the continuous wound pump group.
Conclusions:
This study demonstrates that early experience with an erector spinae block resulted in decreased opioid use and shorter hospital stay as compared with continuous wound infiltration with local anesthetic.
Insights
Erector spinae block anesthesia significantly reduced opioid use by 65% and hospital stay by 1.69 days in pediatric microtia reconstruction patients. This novel approach offers improved pain management compared to traditional methods.
Area of Science:
- Pediatric surgery
- Anesthesiology
- Pain management
Background:
- Autologous microtia reconstruction offers biocompatibility but causes significant postoperative pain from costal cartilage harvest.
- Effective pain management is crucial for pediatric patients undergoing microtia reconstruction.
Purpose of the Study:
- To introduce and evaluate the erector spinae block (ESB) for anesthesia in pediatric microtia reconstruction.
- To assess the impact of ESB on pain scores, opioid consumption, and hospital length of stay.
Main Methods:
- A case series with chart review was conducted on pediatric patients undergoing stage 1 microtia reconstruction.
- Data included demographics, opioid use, pain scores (Wong-Baker FACES), side effects, and hospital stay.
- Statistical analysis used generalized estimating equations and linear regression models.
Main Results:
- The erector spinae block group (14 patients) showed a 65.44% decrease in adjusted total opioid use compared to the continuous wound pump group (33 patients).
- Hospital stay was reduced by an average of 1.69 days in the ESB group.
- No significant difference in reported pain scores was observed between the groups.
Conclusions:
- The erector spinae block is an effective anesthesia technique for pediatric microtia reconstruction.
- ESB leads to reduced opioid requirements and shorter hospitalizations compared to continuous wound infiltration.
- This study highlights the potential of ESB in optimizing postoperative care for microtia surgery.
