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Methods for In Vivo Biomechanical Testing on Brachial Plexus in Neonatal Piglets
Published on: December 19, 2019
"Voiceless Pain"-Assessment of Pain in Patients with Obstetric Brachial Plexus Injuries: A Retrospective, Single
Savas Tsolakidis1, Bong-Sung Kim2, Ziyad Alharbi3,4
1Austrian Cluster of Tissue Regeneration and Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Research Centre for Traumatology of the Austrian Workers' Compensation Board (AUVA), Donaueschingenstraße 13, 1200 Vienna, Austria.
Insights
Most children with obstetric brachial plexus injuries (OBPIs) do not experience lifelong pain. Early microsurgical reconstruction for OBPI may reduce the likelihood of developing chronic pain later in life.
Area of Science:
- Pediatric Orthopedics
- Neurology
- Pain Management
Background:
- Obstetric brachial plexus injuries (OBPIs) can cause significant motor deficits and chronic pain.
- Pain assessment in children with OBPI is often overlooked in routine clinical practice.
- Understanding the long-term pain experience in OBPI patients is crucial for effective management.
Purpose of the Study:
- To investigate the prevalence of lifelong pain in pediatric patients with OBPI.
- To explore the correlation between pain experiences and surgical reconstructive treatment in OBPI patients.
Main Methods:
- A single-center retrospective study involving OBPI patients treated over 20 years.
- Utilized the adolescent pediatric pain tool to assess lifelong pain, excluding immediate postoperative pain.
- Surveyed 78 out of 95 contacted OBPI patients.
Main Results:
- The majority (84.6%) of OBPI patients reported no significant pain in the affected upper extremity.
- Patients who experienced pain were less likely to have undergone early microsurgical reconstruction.
- Only 33.3% of pain-experiencing patients had microsurgical reconstruction at a median age of 7 months.
Conclusions:
- Pain assessment in OBPI patients is frequently neglected in clinical settings.
- Individualized, age-appropriate pain management strategies are essential.
- Early microsurgical reconstruction for OBPI appears to be associated with a lower incidence of lifelong pain.
Background:
Obstetric brachial plexus injuries (OBPIs) not only lead to severe and life changing sequelae regarding motor impairment but can also be responsible for multi-characteristic pain. In everyday routine, questions regarding pain of the developing child with an OBPI are often overseen and neglected. We aimed to elucidate this specific question and analyzed all patients with OBPI treated in our center to unmask initially non-observed pain and ultimately put pain in correlation to the surgical reconstructive treatment performed.
Methods:
This single center retrospective study analyzes patients with OBPI treated in our center over the past 20 years. Patients were surveyed by the adolescent pediatric pain tool assessment to evaluate pain over their entire life span by excluding potential postoperative pain episodes.
Results:
A total of 95 patients were initially contacted of which 78 returned the questionnaire (53.8% female, 46.2% male). In our patient cohort, the vast majority constituting 84.6 percent did not experience pain in the affected upper extremity over the years up to the date of their examination. Most of the patients describing pain had not been microsurgically treated for brachial plexus reconstruction in their neonate period. Merely, 33.3 percent of all OBPI experiencing pain had been microsurgically reconstructed at a median age of 7 months.
Conclusions:
Pain interrogation in patients with OBPI is often overseen during daily clinical routine. Adequate age-appropriate analgesic therapy regimens adapted to the individual are highly recommended. Timely microsurgical brachial plexus reconstruction may result in reduced lifetime pain experiences.
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