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Published on: March 15, 2024
Effect of regional nerve block on tourniquet-related injury in pediatric patients undergoing lower limb surgery: a
Qin Xia1, Rui Chen1, Chao Lin2
1Department of Anesthesiology and Surgical Intensive Care Unit, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Insights
Regional nerve blocks significantly reduce tourniquet-related injuries and opioid use in pediatric knee surgery. This pain management approach also speeds up recovery and reduces hospital stays.
Area of Science:
- Anesthesiology
- Orthopedic Surgery
- Pain Management
Background:
- Regional nerve blocks are recognized for pain management.
- Limited research exists on their role in mitigating tourniquet injuries and improving functional recovery in lower limb surgery.
Purpose of the Study:
- To evaluate the efficacy of combined femoral and sciatic nerve blocks in pediatric patients undergoing knee arthroscopic surgery.
- To assess the impact on tourniquet-related hypertension, pain, opioid consumption, and functional recovery.
Main Methods:
- Randomized controlled trial involving 64 pediatric patients (aged 6-12).
- Intervention group received femoral and sciatic nerve blocks (PNB group); control group received general anesthesia only.
- Primary endpoint: tourniquet-induced hypertension. Secondary endpoints: opioid consumption, pain, inflammation, oxidative stress, adipokines, ambulation time, and hospital stay.
Main Results:
- The PNB group had a significantly lower incidence of tourniquet-induced hypertension (33.33% vs 73.33%).
- Reduced 24-hour oral morphine equivalent consumption by 39% in the PNB group.
- PNB group showed decreased pain, inflammation, oxidative stress, and blood glucose fluctuations, with faster ambulation and shorter hospital stays.
Conclusions:
- Combined femoral and sciatic nerve blocks effectively reduce tourniquet-related injuries in pediatric knee surgery.
- This nerve block technique decreases opioid requirements and enhances postoperative recovery.
- Regional anesthesia facilitates a faster, less painful recovery and shorter hospital duration.
Background:
The efficacy of regional nerve block for pain management has garnered considerable attention. However, few studies have explored their effectiveness in mitigating tourniquet-related injuries and promoting functional recovery in lower limb surgery patients.
Methods:
: Sixty-four pediatric patients aged 6-12 undergoing knee arthroscopic surgery under general anesthesia. All patients were randomized to receive either femoral nerve block combined with sciatic nerve block (the PNB group) or standard general anesthesia only (the control group). The primary endpoint was the incidence of tourniquet-induced hypertension. Secondary endpoints included the cumulative oral morphine equivalent consumption within 24 h post-surgery, the perioperative pain intensity, inflammation and oxidative stress levels (assessed via IL-6, IL-10, SOD, and MDA), plasma levels of circulating adipokines (FABP-4 and Apelin-13), time to first ambulation, and hospital stay duration.
Results:
The PNB group showed a lower incidence of tourniquet-induced hypertension compared with the control group (33.33% vs 73.33%, relative risk [95% confidence interval] of 0.182 [0.06-0.55]; p = 0.004). Patients in the PNB group demonstrated a 39% reduction in oral morphine equivalent consumption at 24 h postoperatively (p < 0.001). In comparison to the control group, the PNB group also exhibited reduced postoperative pain intensity, inflammation, and oxidative stress levels, as well as lower blood glucose fluctuation. Additionally, patients in the PNB group had a significantly shorter time to first ambulation and a shorter hospital length of stay.
Conclusions:
The present study demonstrated that combining femoral nerve block and sciatic nerve block can alleviate tourniquet-related injuries, decrease opioid consumption, facilitate a quicker and less painful recovery period.
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