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Continuous Peripheral Block as a Pain Treatment for Redressment and Physical Therapy in a 7-Year-Old Child - A Case
Ljubica Mikjunovikj-Derebanova1, Ljupco Donev1, Lazar Todorovic2
1University Clinic of Traumatology, Orthopedics, Anesthesiology, Reanimation, Intensive Care and Emergence Center, Skopje, R. N. Macedonia.
Insights
Continuous peripheral nerve blocks provide safe and effective pain management for children, enabling painless physical therapy and early mobilization. This technique minimizes patient trauma and can be administered at home for improved rehabilitation.
Area of Science:
- Pediatric Anesthesiology
- Regional Anesthesia
- Pain Management
Background:
- Continuous peripheral nerve blocks, or local anesthetic perineural infusions, involve catheter placement for prolonged anesthesia or analgesia.
- Pediatric patients often require specialized pain management strategies to minimize trauma and facilitate recovery.
Observation:
- A case study involving a 7-year-old boy with left elbow contracture requiring surgical redressment and physical therapy.
- An ultrasound-guided axillary brachial plexus block was performed with a non-tunneled perineural catheter for pain management.
- The patient underwent two elbow redressment procedures with local anesthetic boluses and experienced painless physical therapy via continuous perineural infusion.
Findings:
- The perineural catheter was safely removed on day 5 without complications like hematoma, infection, or leakage.
- Continuous regional anesthesia in children proved to be a safe and effective postoperative pain management technique.
- Sufficient analgesia and improved patient comfort facilitated early mobilization and rehabilitation.
Implications:
- Continuous regional anesthesia offers a safe method for pediatric postoperative pain control, enhancing patient comfort and recovery.
- This technique supports early mobilization and can be adapted for in-home treatment with proper patient and parent education.
- Minimizing psychological and physical trauma is crucial for pediatric patients, and continuous regional anesthesia contributes to this goal.
Abstract:
Continuous peripheral nerve block, also known as "local anesthetic perineural infusion," refers to percutaneous placement of a catheter near a peripheral nerve or plexus followed by administration of a local anesthetic through a catheter to provide anesthesia, or analgesia for several days, in some cases even for a month. This report describes the case of a 7 year old boy with left elbow contracture with limited flexion and extension who was admitted to the Clinic of Pediatric Surgery for redressment of the elbow and physical therapy. An ultrasound-guided axillary brachial plexus block was performed, with placement of a non-tunneled perineural catheter. Redressment of the left elbow was performed twice and before each redressment boluses of local anesthetic were applied through the perineural catheter. Physical therapy was performed painlessly with continuous perineural infusion. On the 5th day of catheter placement, the perineural catheter was removed without any prior complications such as hematoma, infection, catheter dislocation or leakage of local anesthetic. Our goal is to minimize the psychological and physical trauma to the patient, no matter how immature the patient is. Continuous regional anesthesia in children is a safe technique in postoperative pain management that facilitates early mobilization due to its sufficient analgesia and better comfort. It can provide in-home treatment, with adequate education for patients and parents, and improve rehabilitation in children.
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