Adams Alexander J, Muhly Wallis T, Gurnaney Harshad G, Kerr Joy C, Wells Lawrence
Orthopaedic Surgery, The Children's Hospital of Philadelphia.
Anesthesiology/Critical Care, Children's Hospital of Philadelphia, Philadelphia, USA.
Cureus. 2018 Jun 21;10(6):e2852. doi: 10.7759/cureus.2852.
Introduction Peripheral nerve blockade (PNB) can be a useful component of a multimodal analgesia approach in managing pain after knee arthroscopy. However, the impact of PNB and short-term recovery in pediatric patients, particularly adolescents, who underwent knee arthroscopy for anterior cruciate ligament (ACL) reconstruction and/or meniscus surgery (repair or resection) has not been well characterized. This prospective study presents observational data on short-term patient outcomes and side effects for 72 hours following discharging home of pediatric patients who underwent arthroscopic ACL and/or meniscus procedures with PNB. Methods This is a single-center, single-surgeon prospective observational study conducted over a three-year period. We characterized 72-hour postoperative outcomes including pain scores, return of sensation to the affected limb, analgesic use [nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids], readmission rate, and activities of daily living (ADL) via telephone survey. In addition, retrospective chart review was conducted to obtain perioperative and anesthesia details. Results for surgery groups were analyzed using descriptive and Pearson correlations using the SPSS version 24 (IBM Corp. Released 2016. IBM SPSS Statistics for Mac, Version 24.0. Armonk, NY, USA). Results We collected data on 47 patients undergoing ACL reconstruction with or without meniscus surgery (18/47, 38.3%) or meniscus surgery only (29/47, 61.7%). At 72 hours postsurgery, there were no readmissions or complications related to pain. Median-reported pain scores were 2.5 and 5.0 for the ACL and meniscus groups, respectively. A majority of patients continued to require opioids (45/47, 95.7%) and NSAIDs (46/47, 97.9%) at 72 hours postsurgery, but the number of daily opioid doses taken decreased with each day postoperatively. Over 93% of the patients could ambulate and shower at 72 hours postsurgery. Conclusions Regional nerve block appears to be an effective and safe analgesic strategy for pediatric arthroscopic ACL and meniscus procedures, with no short-term complications or readmissions related to pain in our cohort. Future prospective investigation is needed to characterize long-term pain outcomes in this surgical population.
引言 周围神经阻滞（PNB）可作为膝关节镜检查术后多模式镇痛方法的一个有用组成部分。然而，对于接受前交叉韧带（ACL）重建和/或半月板手术（修复或切除）的儿科患者，尤其是青少年患者，PNB的影响以及短期恢复情况尚未得到充分描述。本前瞻性研究提供了接受关节镜下ACL和/或半月板手术并进行PNB的儿科患者出院后72小时内的短期患者结局和副作用的观察数据。
方法 这是一项在三年期间进行的单中心、单术者前瞻性观察研究。我们通过电话调查对术后72小时的结局进行了描述，包括疼痛评分、患侧肢体感觉恢复情况、镇痛药物使用情况[非甾体类抗炎药（NSAIDs）和阿片类药物]、再入院率以及日常生活活动（ADL）。此外，进行了回顾性病历审查以获取围手术期和麻醉细节。使用SPSS 24版（IBM公司。2016年发布。适用于Mac的IBM SPSS Statistics，版本24.0。美国纽约州阿蒙克）对手术组的结果进行描述性分析和Pearson相关性分析。
结果 我们收集了47例接受ACL重建手术（无论是否同时进行半月板手术）（18/47，38.3%）或仅进行半月板手术（29/47，61.7%）患者的数据。术后72小时，没有因疼痛导致的再入院或并发症。ACL组和半月板组报告的中位疼痛评分分别为2.5和5.0。大多数患者在术后72小时仍需要使用阿片类药物（45/47，95.7%）和NSAIDs（46/47，97.9%），但术后每天服用的阿片类药物剂量随着时间减少。超过93%的患者在术后72小时能够行走和洗澡。
结论 区域神经阻滞似乎是儿科关节镜下ACL和半月板手术的一种有效且安全的镇痛策略，在我们的队列中没有与疼痛相关的短期并发症或再入院情况。需要未来的前瞻性研究来描述该手术人群的长期疼痛结局。
