Department of Orthopaedic Surgery, Shriners Hospitals for Children - Northern California, Sacramento, CA, USA.
Department of Anesthesia, Shriners Hospitals for Children - Northern California, Sacramento, CA, USA.
J Pediatr Rehabil Med. 2022;15(1):3-11. doi: 10.3233/PRM-210027.
The purpose of this study is to describe the efficacy and adverse events of neuraxial anesthesia for post-operative pain control in non-ambulatory children with cerebral palsy with pre-existing intrathecal baclofen (ITB) pumps undergoing hip reconstructive or palliative surgery.
Twelve children (mean age 11.25 years) were included in the study with the following neuraxial anesthesia methods: indwelling epidural catheter (8 patients), neuraxial opioids administered through the side port of the ITB pump (3 patients), and single injection spinal anesthetic (1 patient). Observational pain scores and opioid requirements were quantified for all patients.
There were no ITB pump or surgical complications at a mean follow-up of 2.2 years. The average length of stay was 6 days. Patients had good post-operative pain control with a mean observational pain score of 0.7 and mean morphine equivalent use of 0.26mg/kg/day. Four patients required anti-emetics to control nausea and three patients had urinary retention requiring repeat catheterization, but all medical complications resolved prior to discharge.
Neuraxial anesthesia can effectively control post-operative pain in children with a pre-existing ITB pump. Utilizing the side port of the ITB pump for administration of neuraxial opioids is an option when epidural or spinal anesthesia is not possible.
本研究旨在描述患有脑瘫且预先存在鞘内巴氯芬（ITB）泵的非活动儿童在接受髋关节重建或姑息性手术时，进行椎管内麻醉以控制术后疼痛的疗效和不良事件。
本研究纳入了 12 名儿童（平均年龄 11.25 岁），采用以下椎管内麻醉方法：留置硬膜外导管（8 例）、通过 ITB 泵侧端口给予椎管内阿片类药物（3 例）和单次脊髓麻醉（1 例）。对所有患者进行了观察性疼痛评分和阿片类药物需求的量化。
在平均 2.2 年的随访中，没有发生 ITB 泵或手术相关并发症。平均住院时间为 6 天。患者术后疼痛控制良好，平均观察性疼痛评分为 0.7，平均吗啡等效用量为 0.26mg/kg/天。4 名患者需要止吐药来控制恶心，3 名患者发生尿潴留需要再次导尿，但所有医疗并发症均在出院前得到解决。
椎管内麻醉可有效控制预先存在 ITB 泵的儿童的术后疼痛。当无法进行硬膜外或脊髓麻醉时，可选择使用 ITB 泵的侧端口给予椎管内阿片类药物。
