Departments of1Neurologic Surgery and.
2Pediatric Anesthesiology, Mayo Clinic, Rochester, Minnesota.
J Neurosurg Pediatr. 2020 Oct 2;27(1):9-15. doi: 10.3171/2020.6.PEDS20370. Print 2021 Jan 1.
Pediatric Chiari I malformation decompression is a common neurosurgical procedure. Liposomal bupivacaine (LB) is a novel formulation that can have an impact on postoperative recovery for particular procedures, but its potential role in pediatric neurosurgery is largely unexplored. The authors sought to describe and assess their initial experience with LB in pediatric Chiari I malformation decompression to better define its potential role as an analgesic agent in a procedure for which the postoperative course is often remarkably painful.
A retrospective review of all pediatric Chiari procedures performed at the authors' institution between 2018 and 2020 was conducted. Patients were divided into those who were treated with a single intraoperative dose of LB (LB group) and those who were not (control group). Comparisons of total opioid use and pain control were made using chi-square and Wilcoxon rank-sum tests.
A total of 18 patients were identified, 9 (50%) in the LB group and 9 (50%) in the control group. Overall, there were 13 (72%) female and 5 (28%) male patients with a mean age of 15.9 years. No surgical complications were observed over a mean length of stay of 2.7 days. Within the first 24 hours after surgery, the LB group had significantly lower total opioid use than the control group (17.5 vs 47.9 morphine milligram equivalents, respectively; p = 0.03) as well as lower mean pain scores reported by patients using a 10-point visual analog scale (3.6 vs 5.5 for the LB vs control groups, p = 0.04). However, from the first 24 postoperative hours to discharge, total opioid use (p = 0.51) and mean pain scores (p = 0.09) were statistically comparable between the two groups. There were 2/9 (22%) LB patients versus 0/9 (0%) control patients who did not require opioid analgesia at any point during hospitalization.
The use of a single intraoperative dose of LB in pediatric Chiari I malformation surgery appears to be safe and has the potential to reduce pain scores and opioid use when administered during the first 24 postoperative hours. From that time period to discharge, however, there may be no significant difference in total opioid use or pain scores.
小儿 Chiari I 畸形减压是一种常见的神经外科手术。脂溶性布比卡因（LB）是一种新的制剂，可能对某些手术的术后恢复有影响，但它在小儿神经外科中的潜在作用在很大程度上尚未得到探索。作者旨在描述并评估他们在小儿 Chiari I 畸形减压中使用 LB 的初步经验，以更好地确定其作为一种镇痛剂在术后过程通常非常疼痛的手术中的潜在作用。
对作者所在机构 2018 年至 2020 年间进行的所有小儿 Chiari 手术进行回顾性分析。患者分为接受单次术中 LB 治疗的患者（LB 组）和未接受治疗的患者（对照组）。使用卡方检验和 Wilcoxon 秩和检验比较两组的总阿片类药物使用量和疼痛控制情况。
共确定了 18 例患者，LB 组 9 例（50%），对照组 9 例（50%）。总体而言，13 例（72%）为女性，5 例（28%）为男性，平均年龄为 15.9 岁。平均住院时间为 2.7 天，无手术并发症。术后 24 小时内，LB 组总阿片类药物使用量明显低于对照组（分别为 17.5 和 47.9 吗啡毫克当量；p = 0.03），且患者使用 10 分视觉模拟评分法报告的平均疼痛评分也较低（LB 组为 3.6，对照组为 5.5；p = 0.04）。然而，从术后 24 小时到出院，两组的总阿片类药物使用量（p = 0.51）和平均疼痛评分（p = 0.09）均无统计学差异。LB 组有 2/9（22%）例患者和对照组有 0/9（0%）例患者在住院期间任何时候均无需使用阿片类镇痛药。
在小儿 Chiari I 畸形手术中单次使用 LB 似乎是安全的，并且在术后 24 小时内使用时有可能降低疼痛评分和阿片类药物使用量。然而，从该时间点到出院，总阿片类药物使用量或疼痛评分可能没有显著差异。
