Peripheral Nerve Blocks in Patients With Osteogenesis Imperfecta Undergoing Extremity Procedures are Safe and
Isaiah J Rhodes1, Timothy E Hereford1, Kesavan Sadacharam2
1Department of Orthopaedic Surgery, Nemours Children's Health, Wilmington, DE, USA.
Background:
A paucity of data is available regarding regional nerve blocks in patients with osteogenesis imperfecta (OI) undergoing extremity procedures. We report a series of regional nerve blocks for patients with OI undergoing reconstructive extremity procedures.
Methods:
This was a retrospective review of patients with OI undergoing extremity orthopaedic procedures from July 2018 to September 2023. Chart review was completed for demographics, OI type, procedures, type of block, opioid use, pain scores and any complication.
Results:
Ninety surgical encounters involving 58 patients (34 male) were identified. The average age at surgery was 11.8 (2-33) years. Osteogenesis imperfecta type III was the most common type encountered (35.6% of patients). Femoral realignment and rodding (26.6%) were the most common procedures performed (13 primary, 22 revisions). The most common block was the lumbar plexus (36). Intraoperative average morphine milligram equivalent (MME)/kg was 1.0 (0-3.1). Pediatric acute care unit (PACU) average MME/kg was 0.1 (0-0.4). Total MME/kg for the first 24 h and from 24 to 48 h postoperatively were 0.3 (0-1.4) and 0.4 (0-1.7) respectively. Average pain scores in the PACU, the first 24 h, and 24-48 h postoperatively was 1.2 (0-9, standard deviation [SD] = 1.9), 2.1 (0-8, SD = 1.8), and 2.2 (0-8, SD = 2.0), respectively. No significant adverse events related to the regional blocks were noted.
Conclusion:
In this series of patients with OI undergoing extremity procedures, the use of regional blocks and indwelling catheters was associated with no adverse events. Patients had low pain scores and minimal postoperative opioid use.
Level Of Evidence:
IV.
Key Concepts:
(1)Postoperative pain control is critical for OI patients with frequent surgeries.(2)Peripheral nerve blocks with catheters are safe and effective for OI patients.(3)Peripheral nerve blocks with catheters are best part of a multimodal pain regimen.(4)Use special care with brittle bones when positioning for catheter placement.(5)Plan with the OR team to avoid catheter dressings interfering with the sterile field.
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