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PEDIATRIC ANESTHESIOLOGY

Continuous Peripheral Nerve Blockade for Inpatient and Outpatient Postoperative Analgesia in Children

Arjunan Ganesh, MBBS^*, John B. Rose, MD^*, Lawrence Wells, MD, Theodore Ganley, MD, Harshad Gurnaney, MD^*, Lynne G. Maxwell, MD^*, Theresa DiMaggio, MSN^*, Karen Milovcich, MSN^*, Maureen Scollon, MSN^*, Jeffrey M. Feldman, MD^*, and Giovanni Cucchiaro, MD^*

From the *Department of Anesthesia and Critical Care Medicine, The Children's Hospital of Philadelphia; University of Pennsylvania School of Medicine; and Department of Orthopedics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.

Address correspondence and reprint requests to Arjunan Ganesh, MBBS, Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, 34th St. and Civic Center Blvd., Philadelphia, PA 19104-4399. Address e-mail to ganesha{at}email.chop.edu.

Abstract

BACKGROUND: This is an audit of the continuous peripheral nerve blockade (CPNB) program that was implemented at our institution to provide postoperative analgesia after orthopedic procedures in children.

METHODS: We reviewed the departmental regional anesthesia registry and the medical records of consecutive children who received CPNB for postoperative analgesia at The Children's Hospital of Philadelphia between February 2003 and July 2006. Patients were prospectively followed until cessation of the effects of CPNB and/or resolution of any related complications. Data collected contemporaneously included presence of sensory and motor blockade, pain scores in inpatients, opioid administration, and complications related to CPNB.

RESULTS: A total of 226 peripheral nerve catheters were placed in 217 patients. One hundred eight patients (112 catheters) were discharged home with CPNB. The ages ranged from 4 to 18 yr (13.7 ± 3.4). Local anesthetic solution (0.125% bupivacaine [n = 164], 0.1% ropivacaine [n = 12], or 0.15% ropivacaine [n = 27]) was infused at an initial rate of 2–12 mL/h based on patients' weights and locations of catheters. The mean duration of local anesthetic infusion was 48.4 ± 29.3 h (range 0–160 h). The percentage of patients who did not require any opioids in the first 8, 24, and 48 h after surgery was 56%, 26%, and 21%, respectively. The incidence of nausea and vomiting was 14% (13% in outpatients, 15% in inpatients). Complications were noted in 2.8% of patients. Three patients had prolonged numbness (>24 h) that resolved spontaneously; one developed superficial cellulitis that resolved with a course of antibiotics; one had difficulty removing the catheter at home and one developed tinnitus 24 h after starting CPNB that resolved quickly after clamping of the catheter followed by removal.

CONCLUSION: It is feasible to implement a CPNB program to provide an alternative method of inpatient and outpatient postoperative analgesia after orthopedic surgery in children when appropriate expertise is available. Patient and family education along with frequent follow-up are crucial to detect and address adverse events promptly.

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