Department of Orthopaedic Surgery, Riverside University Health System-Medical Center, Moreno Valley.
CHOC Children's Hospital.
J Pediatr Orthop. 2022 Apr 1;42(4):e356-e361. doi: 10.1097/BPO.0000000000002082.
Levels of opioid misuse and addiction among children and adolescents have reached alarming proportions. Exposure to opioids after surgery for anterior cruciate ligament reconstruction (ACLR), which is commonly performed in young athletes, increases this risk. This study was designed to evaluate whether continuous peripheral nerve block (CPNB) with placement of an elastomeric reservoir ball, compared with single-shot peripheral nerve block (SPNB), would decrease the need for home opioid analgesia and improve pain control after ACLR in children and adolescents.
Prospectively collected data from a consecutive cohort that underwent ACLR by a single surgeon were retrospectively reviewed. Patients who received ACLR with 72-hour CPNB were assigned to Group 1. Patients who received ACLR with SPNB were assigned to Group 2. Postoperative pain management included cryotherapy, oral acetaminophen, and ibuprofen. A prescription for 10 doses of hydrocodone/acetaminophen (5/325 mg) was provided in a sealed envelope with instructions that the prescription should only be used in the case of uncontrolled pain. Reports of no opioid use were corroborated by the unopened envelope and unfilled prescription.
One hundred and ninety-six patients were enrolled in the study (SPNB=114 patients, CPNB=82 patients). Average age was 15±1.5 years (115 female). A total of 138 patients (70%) did not need home opioid analgesia after surgery. Of the 58 patients (30%) that did there were 35 (30.7%) in the SPNB group and 23 (28.0%) in the CPNB group (P=0.659). There were no differences between groups in demographics, operative data, or visual analog scale scores on any postoperative day.
The findings of this study demonstrate equivalent pain control and opioid consumption in children and adolescents undergoing ACLR treated with either a CPNB or a SPNB. At-home opioid analgesia use can be negated after ACLR in 70% of children and adolescents. For the patients in this study who required opioids, average use was only 2 pills of 5 mg hydrocodone/325 mg acetaminophen, with no child using more than 10 pills.
Level II-therapeutic.
儿童和青少年阿片类药物滥用和成瘾的水平已经达到了惊人的程度。在进行前交叉韧带重建术（ACLR）后接触阿片类药物会增加这种风险，而 ACLR 通常是在年轻运动员中进行的。本研究旨在评估与单次外周神经阻滞（SPNB）相比，带弹性储球的连续外周神经阻滞（CPNB）是否会减少儿童和青少年 ACLR 后的家庭阿片类镇痛药需求并改善疼痛控制。
回顾性分析了一位外科医生连续进行的 ACLR 的前瞻性收集数据。接受 ACLR 并接受 72 小时 CPNB 的患者被分配到第 1 组。接受 ACLR 并接受 SPNB 的患者被分配到第 2 组。术后疼痛管理包括冷敷、口服对乙酰氨基酚和布洛芬。提供了一个密封信封，内有 10 剂氢可酮/对乙酰氨基酚（5/325mg）的处方，并附有说明，只有在疼痛无法控制的情况下才应使用该处方。无阿片类药物使用的报告通过未开封的信封和未填写的处方得到证实。
共有 196 名患者入组研究（SPNB=114 例，CPNB=82 例）。平均年龄为 15±1.5 岁（115 名女性）。共有 138 名患者（70%）手术后无需家庭阿片类镇痛药。在需要的 58 名患者中（30%），SPNB 组中有 35 名（30.7%），CPNB 组中有 23 名（28.0%）（P=0.659）。两组在人口统计学、手术数据或任何术后日的视觉模拟评分方面均无差异。
本研究的结果表明，接受 CPNB 或 SPNB 治疗的 ACLR 儿童和青少年的疼痛控制和阿片类药物消耗相当。在 70%的儿童和青少年中，可以消除 ACLR 后家庭阿片类镇痛药的使用。对于本研究中需要阿片类药物的患者，平均使用量仅为 5mg 氢可酮/325mg 对乙酰氨基酚的 2 片，没有儿童使用超过 10 片。
II 级治疗。
