Ganesh Arjunan, Rose John B, Wells Lawrence, Ganley Theodore, Gurnaney Harshad, Maxwell Lynne G, DiMaggio Theresa, Milovcich Karen, Scollon Maureen, Feldman Jeffrey M, Cucchiaro Giovanni
Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104-4399, USA.
Anesth Analg. 2007 Nov;105(5):1234-42, table of contents. doi: 10.1213/01.ane.0000284670.17412.b6.
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.
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.
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.
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.
这是一项对我们机构实施的连续外周神经阻滞（CPNB）项目的审计，该项目旨在为儿童骨科手术后提供术后镇痛。
我们回顾了费城儿童医院2003年2月至2006年7月间接受CPNB进行术后镇痛的连续儿童的科室区域麻醉登记册和病历。对患者进行前瞻性随访，直至CPNB作用停止和/或任何相关并发症得到解决。同时收集的数据包括感觉和运动阻滞的存在情况、住院患者的疼痛评分、阿片类药物的使用以及与CPNB相关的并发症。
共为217例患者放置了226根外周神经导管。108例患者（112根导管）在CPNB状态下出院回家。年龄范围为4至18岁（13.7±3.4）。根据患者体重和导管位置，以2 - 12 mL/h的初始速率输注局部麻醉溶液（0.125%布比卡因[n = 164]、0.1%罗哌卡因[n = 12]或0.15%罗哌卡因[n = 27]）。局部麻醉输注的平均持续时间为48.4±29.3小时（范围0 - 160小时）。术后第1个8小时、24小时和48小时内不需要任何阿片类药物的患者百分比分别为56%、26%和21%。恶心和呕吐的发生率为14%（门诊患者为13%，住院患者为15%）。2.8%的患者出现并发症。3例患者出现长时间麻木（>24小时），随后自行缓解；1例发生浅表蜂窝织炎，经抗生素治疗后缓解；1例在家中拔管困难；1例在开始CPNB后24小时出现耳鸣，在夹闭导管并随后拔除后迅速缓解。
当具备适当专业知识时，实施CPNB项目为儿童骨科手术后的住院和门诊患者提供一种替代的术后镇痛方法是可行的。对患者及其家属进行教育并频繁随访对于及时发现和处理不良事件至关重要。
