Pisapia Jared M, Doherty Tara M, Grosinger Liana, Huang Audrey, Muh Carrie R, Abramowicz Apolonia E, Xu Jeff L
Department of Neurosurgery, Westchester Medical Center, Valhalla, NY 10595, USA.
School of Medicine, New York Medical College, Valhalla, NY 10595, USA.
Healthcare (Basel). 2024 Jul 17;12(14):1426. doi: 10.3390/healthcare12141426.
Surgery for lesions of the posterior fossa is associated with significant postoperative pain in pediatric patients related to extensive manipulation of the suboccipital musculature and bone. In this study, we assess the preliminary safety, effect on neuromonitoring, and analgesic efficacy of applying a cervical paraspinal interfascial plane block in pediatric patients undergoing posterior fossa surgery.
In this prospective case series, we enrolled five patients aged 2-18 years undergoing surgery for symptomatic Chiari type I malformation. An ultrasound-guided cervical cervicis plane (CCeP) block was performed prior to the incision. A local anesthetic agent (bupivacaine) and a steroid adjuvant (dexamethasone) were injected into the fascial planes between the cervical semispinalis capitis and cervical semispinalis cervicis muscles at the level of the planned suboccipital decompression and C1 laminectomy. Motor-evoked and somatosensory-evoked potentials were monitored before and after the block. Patients were assessed for complications from the local injection in the intraoperative period and for pain in the postoperative period.
No adverse events were noted intraoperatively, and there were no changes in neuromonitoring signals. Pain scores were low in the immediate postoperative period, and rescue medications were minimal. No complaints of incisional pain or need for narcotics were noted at the time of the 3-month postsurgical follow-up.
In this study, we demonstrate the preliminary safety and analgesic efficacy of a novel application of a CCeP block to pediatric patients undergoing suboccipital surgery. Larger studies are needed to further validate the use of this block in children.
后颅窝病变手术会给儿科患者带来显著的术后疼痛，这与枕下肌肉组织和骨骼的广泛操作有关。在本研究中，我们评估了在接受后颅窝手术的儿科患者中应用颈旁椎旁筋膜平面阻滞的初步安全性、对神经监测的影响及镇痛效果。
在这个前瞻性病例系列中，我们纳入了5例年龄在2至18岁、因症状性Chiari I型畸形接受手术的患者。在切口前进行超声引导下的颈颈平面（CCeP）阻滞。将局部麻醉剂（布比卡因）和类固醇佐剂（地塞米松）注入计划进行枕下减压和C1椎板切除术水平的头半棘肌和颈半棘肌之间的筋膜平面。在阻滞前后监测运动诱发电位和体感诱发电位。评估患者术中局部注射的并发症以及术后的疼痛情况。
术中未观察到不良事件，神经监测信号也无变化。术后即刻疼痛评分较低，急救药物使用极少。术后3个月随访时未发现切口疼痛或需要使用麻醉剂的主诉。
在本研究中，我们证明了CCeP阻滞在接受枕下手术的儿科患者中的新应用的初步安全性和镇痛效果。需要更大规模的研究来进一步验证该阻滞在儿童中的应用。
