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PEDIATRIC ANESTHESIA

Perioperative Continuous Peripheral Nerve Blocks with Disposable Infusion Pumps in Children: A Prospective Descriptive Study

Department of Anesthesia and Critical Care Medicine, Lapeyronie University Hospital, Montpellier, France

Address correspondence and reprint requests to Xavier Capdevila, MD, PhD, Département d’Anesthésie Réanimation A, Hôpital Lapeyronie, 371 Avenue du Doyen G. Giraud, 34295 Montpellier, France. Address e-mail to x-capdevila{at}chu-montpellier.fr

Continuous peripheral nerve blocks (CPNB) after pediatric major orthopedic surgery are not widely used. We conducted a prospective descriptive study to evaluate the effectiveness of disposable elastomeric pumps for CPNB in children. After inducing general anesthesia, 25 consecutive children scheduled for major orthopedic surgery received a 0.5-mL/kg bolus of a mixture of 1% lidocaine with epinephrine and 0.25% bupivacaine in axillary, femoral, or popliteal catheters. After surgery, disposable pumps with 0.2% ropivacaine were connected. Pump flows were adjusted to the patient’s weight. Postoperative pain was evaluated using a visual analog scale or Children and Infants Postoperative Pain Scale scores at H1, H6, H12, H24, and H48, as well as amounts of rescue analgesia, adverse events, and motor and sensory block. An ambulation score for the children was also evaluated. Eleven popliteal, nine femoral, and five axillary continuous blocks were performed. All the blocks were effective for surgery. The mean total dose consumption of 0.2% ropivacaine was 10.1 mg/kg. Disposable pump flow varied from -9.61% to +8.6% compared with the theoretical one. Postoperative analgesia was excellent. The median of pain score was zero at each period studied. Sensory and motor block were noted at H1 and decreased from the sixth hour. No adverse events were noted. We concluded that the use of elastomeric disposable pumps for CPNB in children was an effective technique.

IMPLICATIONS: In children, continuous nerve blocks with disposable pumps allow optimal analgesia and early ambulation after orthopedic surgeries.

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