Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
Department of Orthopaedics and Trauma Surgery, National Trauma Center, National Academy of Medical Sciences, Mahankal, Kathmandu, Nepal.
J Orthop Surg Res. 2020 Jul 6;15(1):246. doi: 10.1186/s13018-020-01778-4.
Postoperative pain in children has always been inadequately evaluated. This study aims to evaluate the postoperative pain response using an additional dose of brachial plexus block (BPB) for younger children receiving elbow surgeries under general anesthesia (GA).
This retrospective case-control study included pediatric patients (3-10 years) who underwent surgeries for elbow injuries between January 2015 and January 2019. Patients with previous history of surgeries around the elbow, neurological impairment of injured limb, polytrauma, undergoing pain management for different causes, and open or old fractures were excluded. Patients were dichotomized into the GA group and the GA + BPB group as per the presence or absence of BPB.
In all, 150 patients (102/48, male/female) in the GA and 150 patients (104/46, male/female) in the GA + BPB group were included. There existed no significant differences between the two groups in age, sex, fracture side, and types of elbow procedures. As for the pain response after lateral condyle fracture of the humerus (LCFH), the FLACC pain scale was significantly higher for those in the GA group (6.2 ± 0.8) when compared to the GA + BPB group (1.6 ± 0.5) (P < 0.001). As for the pain response after medial epicondyle fracture of the humerus (MCFH), the FLACC pain scale was significantly higher for those in the GA group (6.0 ± 0.8) when compared to the GA + BPB group (1.5 ± 0.5) (P < 0.001). As for the pain response after supracondylar fracture of the humerus (SCFH), the FLACC pain scale was significantly higher for those in the GA group (6.0 ± 0.8) when compared to the GA + BPB group (1.6 ± 0.5) (P < 0.001). As for the pain response after cubitus varus correction, the FLACC pain scale was significantly higher for those in the GA group (6.7 ± 0.7) when compared to the GA + BPB group (2.1 ± 0.7) (P < 0.001).
An additional shot of BPB for patients undergoing surgeries for elbow surgeries resulted in better postoperative pain response in younger children without significant BPB-related complications.
儿童术后疼痛一直未得到充分评估。本研究旨在评估在全身麻醉（GA）下接受肘部手术的幼儿使用额外剂量臂丛阻滞（BPB）后的术后疼痛反应。
本回顾性病例对照研究纳入了 2015 年 1 月至 2019 年 1 月期间因肘部损伤接受手术的儿科患者（3-10 岁）。排除了既往肘部手术史、患肢神经功能障碍、多发伤、因不同原因接受疼痛管理以及开放性或陈旧性骨折的患者。根据是否存在 BPB，患者分为 GA 组和 GA+BPB 组。
共纳入 GA 组 150 例（男/女，102/48）和 GA+BPB 组 150 例（男/女，104/46）。两组患者在年龄、性别、骨折侧和肘部手术类型方面无显著差异。在肱骨外髁骨折（LCFH）后疼痛反应方面，GA 组（6.2±0.8）的 FLACC 疼痛评分明显高于 GA+BPB 组（1.6±0.5）（P<0.001）。在肱骨内上髁骨折（MCFH）后疼痛反应方面，GA 组（6.0±0.8）的 FLACC 疼痛评分明显高于 GA+BPB 组（1.5±0.5）（P<0.001）。在肱骨髁上骨折（SCFH）后疼痛反应方面，GA 组（6.0±0.8）的 FLACC 疼痛评分明显高于 GA+BPB 组（1.6±0.5）（P<0.001）。在肘内翻矫正术后疼痛反应方面，GA 组（6.7±0.7）的 FLACC 疼痛评分明显高于 GA+BPB 组（2.1±0.7）（P<0.001）。
在接受肘部手术的幼儿中，额外注射 BPB 可改善术后疼痛反应，且无明显与 BPB 相关的并发症。
