The effectiveness of ambulatory continuous peripheral nerve blocks for postoperative pain management in children and adolescents

• Published in: Pediatric anesthesia Vol. 24; no. 11; pp. 1141 - 1148
• Main Authors: Visoiu, Mihaela, Joy, Lendi N., Grudziak, Jan S., Chelly, Jacques E.
• Format: Journal Article
• Language: English
• Published: France Blackwell Publishing Ltd 01.11.2014; Wiley Subscription Services, Inc
• Subjects: Adolescent; Adult; Amides - administration & dosage; Amides - therapeutic use; Analgesics - therapeutic use; Anesthetics, Local - administration & dosage; Anesthetics, Local - therapeutic use; Catheters; Child; Child, Preschool; Drug Delivery Systems - methods; Female; Humans; local anesthetics; Male; Nerve Block - instrumentation; Nerve Block - methods; outpatient; Outpatients; Pain Measurement - methods; Pain, Postoperative - drug therapy; Patient Satisfaction - statistics & numerical data; regional; Retrospective Studies; Severity of Illness Index; Treatment Outcome; Young Adult; local anesthetics; outpatient; regional; child
• ISSN: 1155-5645; 1460-9592
• DOI: 10.1111/pan.12518

Summary Background Ambulatory continuous peripheral nerve blocks (CPNBs) are feasible for pediatric patients. We sought to evaluate the efficacy of CPNBs in a pediatric population. Methods This retrospective report of 33‐month prospectively collected data investigates patient, parent, and nurse pain control satisfaction score (PCSS), the incidence and severity of pain, daily analgesic consumption following discharge home with various CPNBs and On‐Q pumps, and any complications and side effects related to CPNBs. Results Four hundred and three patients (403; aged 5–22) were discharged home with 410 CPNBs (brachial and lumbar plexus, femoral, sciatic, and paravertebral); 76.7% on the day of surgery. The median/interquartile range (IQR) ropivacaine continuous infusion via On‐Q pump was 0.24 (0.20–0.30) mg·kg−1·hr−1, and the median/IQR duration was 72 (48–72) h. The median/IQR home PCSS was 10 (9–10). Median Postoperative Ambulatory Care Unit (PACU)/IQR pain control satisfaction scores were 10 (8–10) for the patient, 10 (9–10) for the parent, and 10 (9–10) for the nurse. Thirty‐three (10.0%) patients did not report any pain at home, and median maximum home/IQR pain score was 4 (2–6). In the PACU, 126 (31.3%) patients did not report any pain and median/IQR pain score was 1 (0–3). No opioids were administered at home for 12 (4.3%) patients and in the PACU for 150 (37.4%). Sixty‐three (14.4%) complications and side effects for 58 patients were reported. We report 93.1% ambulatory efficacy of CPNBs. Conclusion Our patients and their caregivers were very satisfied with ambulatory CPNBs. When combined with oral analgesics, CPNBs provided effective home postoperative analgesia.