外周神经阻滞用于小儿膝关节手术后残留神经症状减少：机构使用改变后的结果

Decrease in Residual Neurological Symptoms After Institutional Changes in Peripheral Nerve Block Use for Pediatric Knee Surgery.

机构信息

Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD.

出版信息

J Pediatr Orthop. 2022 Feb 1;42(2):e138-e142. doi: 10.1097/BPO.0000000000002014.

DOI:10.1097/BPO.0000000000002014

PMID:34995258

Abstract

BACKGROUND

Peripheral nerve blocks (PNBs) have recently been associated with a higher incidence of complications than previously thought. We compared: (1) incidence of PNB-related residual neurological symptoms and (2) patient selection, operative practices, and anesthesia practices for pediatric knee surgery patients before and after changes in PNB administration at our institution.

METHODS

We compared data from pediatric patients who underwent knee surgery with PNBs from 2014 to 2016 (cohort 1; 100 patients) or 2017 to 2019 (cohort 2; 104 patients). Cohort 2 was treated after PNB administration was limited to a dedicated anesthesia block team at our institution. We used t tests and χ2 tests, with an α level of 0.05.

RESULTS

The incidence of PNB-related neurological complications was lower in cohort 2 (0.96%;) than cohort 1 (6%) (P=0.045). The 1 complication in cohort 2 was numbness proximal to the knee. Cohort 1 had 5 cases of numbness proximal to the knee and 1 case of neuropathic pain upon palpation of the PNB site. The proportion of female patients was greater in cohort 2 (57%) than cohort 1 (36%) (P=0.01); age and body mass index did not differ between cohorts. In cohort 2, the mean operating time was longer, and tourniquets were used more frequently (both, P<0.01). A greater proportion of PNBs were performed by fellows in cohort 2 (67%) versus cohort 1 (55%) (P=0.01). A smaller proportion of PNBs were performed by residents in cohort 2 (6.9%) versus cohort 1 (16%) (P=0.01). The most common anatomic site for PNBs was the femoral nerve (51%) in cohort 1 and the saphenous nerve (51%) in cohort 2 (P<0.01).

CONCLUSIONS

The incidence of PNB-related complications after pediatric knee surgery decreased significantly after institutional changes in the regulation of PNB use. This decrease may be explained by shifts toward more experienced providers administering PNBs and preference for more distal anatomic sites, suggesting ways other institutions may lower their PNB complication rates.

LEVEL OF EVIDENCE

Level III-retrospective prognostic study.

摘要

背景

与以往相比，外周神经阻滞（PNB）最近与更高的并发症发生率相关。我们比较了：（1）PNB 相关残留神经症状的发生率；（2）在我们机构改变 PNB 给药后，小儿膝关节手术患者的患者选择、手术操作和麻醉操作。

方法

我们比较了 2014 年至 2016 年（队列 1；100 例患者）或 2017 年至 2019 年（队列 2；104 例患者）接受膝关节 PNB 手术的小儿患者的数据。队列 2 在我们机构接受治疗，PNB 给药仅限于专门的麻醉阻滞团队。我们使用 t 检验和 χ2 检验，α 水平为 0.05。

结果

队列 2（0.96%）的 PNB 相关神经并发症发生率低于队列 1（6%）（P=0.045）。队列 2 中的 1 例并发症为膝关节近端麻木。队列 1 中有 5 例膝关节近端麻木和 1 例 PNB 部位触诊时出现神经病理性疼痛。队列 2 中的女性患者比例（57%）高于队列 1（36%）（P=0.01）；年龄和体重指数在队列之间没有差异。在队列 2 中，手术时间更长，止血带使用更频繁（均 P<0.01）。队列 2 中接受神经阻滞的医师以研究员为主（67%），而队列 1 中以住院医师为主（55%）（P=0.01）。队列 2 中接受神经阻滞的住院医师比例较小（6.9%），而队列 1 中为 16%（P=0.01）。最常见的 PNB 解剖部位是股神经（51%），队列 1 和隐神经（51%），队列 2（P<0.01）。