Using a femoral nerve block in paediatric patients undergoing knee surgery leads to less opioid use and allows the majority of patients to go home within hours of surgery, according to a study published in the Journal of Pediatric Orthopedics.
“Our goal with this technique is to reduce pain, which improves patient outcomes and patient satisfaction,” said Tarun Bhalla, MD, Nationwide Children’s Hospital, Columbus, Ohio. “We also use fewer pain medicines intraoperatively as well as postoperatively, so we could really avoid a lot of the side effects that come along with them. We’re localising our numbing medicine to the area where the incision is being made to keep the coverage localised.”
The study also showed for patients who did require hospitalisation spent fewer days inpatient as a result of ultrasound-guided regional anaesthesia.
“With a significant reduction of inpatient stays, patients are going home within a couple hours after coming out of surgery and they have an easier recovery,” said Dr. Bhalla. “I think the quality of recovery is much better because the patients are so much more comfortable at home and not surrounded by the sounds of hospital machines.”
For the study the researchers reviewed records of 376 patients aged 7 to 18 years who underwent arthroscopic knee surgery at Nationwide Children’s between July 2008 and July 2011. Of these patients, 131 received a femoral nerve block in addition to general anaesthesia, while 245 received general anaesthesia alone.
Patients who received the combined anaesthesia reported less pain, required less pain medication after surgery, and had shorter hospital stays when compared with patients who had general anaesthesia alone. This included 98% of ACL reconstructions, which are considered to be one of the most painful of all procedures evaluated in the study.
While the study looked specifically at arthroscopic knee surgery, regional anaesthesia is also becoming more widely used in orthopaedic procedures in the shoulder, elbow, wrist, and in other surgical procedures in the abdomen.
“Ultrasound-guided regional anaesthesia is being used more regularly in paediatric patients, and more often in younger and younger patients,” said Dr. Bhalla. “One of the most significant side effects of opioid use in infants is depressed respiratory function, which leads many infants to require intubation. Reducing the need for narcotics helps the infants come off ventilation more quickly.”
SOURCE: Nationwide Children’s Hospital