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Long-term Complications From Peripheral Nerve Blocks After Pediatric Orthopaedic Lower Extremity Procedures: A
Sunny M Trivedi1,2, Charlotte F Wahle3,2, Yifan V Mao3,2
1Department of Orthopaedic Surgery, Loma Linda University, Loma Linda, California, USA.
Insights
Peripheral nerve blocks (PNBs) are common in pediatric orthopaedic surgery. While rare, long-term complications like chronic pain and motor deficits can occur after lower extremity procedures.
Area of Science:
- Anesthesiology
- Pediatric Orthopaedics
- Regional Anesthesia
Background:
- Peripheral nerve blocks (PNBs) are widely used for pediatric orthopaedic surgery.
- PNBs aid in postoperative pain management and faster discharge.
- Long-term complication rates after PNBs in children are not well-established.
Purpose of the Study:
- To determine the frequency of long-term complications in pediatric patients.
- Focus on patients undergoing lower extremity orthopaedic procedures with regional anesthesia.
Main Methods:
- Systematic review adhering to PRISMA guidelines.
- Searched literature for studies reporting long-term complications (≥6 weeks) after PNBs in pediatric patients.
- Included data on block type, location, procedure, patient age, and outcomes.
Main Results:
- 16 of 158 studies (10%) discussed long-term complications.
- 9 studies reported complications, 7 reported none.
- Common complications included motor deficits (10%), reduced range of motion (12%), chronic pain (5%), and sensory deficits (0.07%).
Conclusions:
- Persistent complications can occur in pediatric patients receiving PNBs for lower extremity orthopaedic surgery.
- However, the reported incidence of these long-term issues in the literature is infrequent.
Background:
Peripheral nerve blocks (PNBs) are frequently utilized as a regional anesthetic in pediatric orthopaedic surgery for postoperative pain control and reduced time to discharge; however, short- and long-term complications after these procedures are variably reported.
Purpose:
To identify the frequency of long-term complications in pediatric patients who received regional anesthesia for a lower extremity orthopaedic procedure.
Study Design:
Systematic review; Level of evidence, 4.
Methods:
A systematic literature search was performed using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Data were collected on pediatric patients, which included the following: block type, block location, procedure type, patient age, experimental design, and reported outcomes. Full texts were then thoroughly examined to determine whether the article made specific references to long-term (≥6 weeks) complications in pediatric patients who received PNBs.
Results:
A total of 158 studies were assessed for eligibility. There were 16 of 158 (10%) studies that met inclusion criteria of having a discussion on follow-up to evaluate for long-term complications (≥6 weeks) from pediatric PNBs. Of these 16 studies, 9 documented long-term complications, while 7 reported no complications. The most common complications were motor deficits, chronic pain, reduced range of motion, and neurological paresthesia. Of the 9 studies reporting long-term complications related to PNBs, 16 of 352 patients across 2 studies (5%) reported chronic pain, 45 of 466 patients across 4 studies (10%) reported strength deficits, 16 of 135 patients across 2 studies (12%) reported reduced range of motion, and 11 of 15,387 patients across 4 studies (0.07%) reported sensory deficits.
Conclusion:
Persistent complications occurred in pediatric orthopaedic patients undergoing lower extremity procedures with PNBs; however, reports in the current literature were rare.
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