McCoy Nicole C, DePriest Brittany P
Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, USA.
Department of Pediatric Hematology and Oncology, Medical University of South Carolina, Charleston, USA.
Cureus. 2023 Oct 25;15(10):e47629. doi: 10.7759/cureus.47629. eCollection 2023 Oct.
Bone marrow harvesting is a means to obtain stem cells to treat certain hematologic conditions in related or unrelated individuals. The most cited complication after bone marrow harvesting is surgical site pain. We developed a protocol incorporating regional anesthesia to improve pain control and reduce opioid use. A retrospective chart review was performed on three pediatric patients who underwent bone marrow harvesting for a sibling recipient and were managed via a standardized regional pain protocol. Each patient was treated with bilateral quadratus lumborum blocks in the operating room, prior to incision. Anesthesia records were reviewed for opioid administration intraoperatively and postoperatively. Two of three patients underwent successful QL blocks as evidenced by pain scores of 0/10 and lack of opioid administration in the post-anesthesia care unit. One patient was found to have a failed block and exhibited pain in the immediate and post-discharge time frame. Following this outpatient procedure, all patients were discharged home to the care of their parents, and no patients required admission due to pain. By utilizing the framework of a successful regional anesthesia model adapted from our adult bone marrow donor patients, we were able to employ a minimal opioid anesthetic and reunite patients with their families efficiently. We continue to use quadratus lumborum blocks in our pediatric patients to facilitate perioperative analgesia.
骨髓采集是获取干细胞以治疗相关或无关个体某些血液系统疾病的一种手段。骨髓采集后最常被提及的并发症是手术部位疼痛。我们制定了一项纳入区域麻醉的方案，以改善疼痛控制并减少阿片类药物的使用。对三名接受骨髓采集以用于同胞受者的儿科患者进行了回顾性病历审查，这些患者通过标准化的区域疼痛方案进行管理。每位患者在手术室切口前接受双侧腰方肌阻滞治疗。审查麻醉记录以了解术中及术后阿片类药物的使用情况。三名患者中有两名成功接受了腰方肌阻滞，麻醉后护理单元的疼痛评分为0/10且未使用阿片类药物即可证明。一名患者的阻滞失败，并在术后即刻及出院后出现疼痛。在这次门诊手术后，所有患者均出院回家由父母照顾，没有患者因疼痛需要住院治疗。通过采用源自我们成年骨髓供者患者的成功区域麻醉模型框架，我们能够使用最低限度的阿片类麻醉药物，并有效地让患者与家人团聚。我们继续在儿科患者中使用腰方肌阻滞来促进围手术期镇痛。
