P20
REGIONAL ANAESTHESIA IN PAEDIATRIC ORTHOPAEDIC SURGERY IN EDINBURGH RHCYP
J. Coe, R. Cowden, S. Y. Ong, J. Messner, M. Hamilton, J. McCormack
NHS Lothian, Edinburgh, UK
Background, context and problem
Over the last 10-15 years there has been an increase in the use of paediatric regional anaesthesia with a recent study showing it being used in 31% of paediatric anaesthetics in Europe. This remains lower in the UK with only 16% of paediatric anaesthetics cases utilising a regional technique. (1)
The recent publication of paediatric plan a blocks ‘aims to bring regional anaesthesia to a wider audience by making basic skills and patient access more widespread’. (2)
In our centre we utilise regional anaesthetic techniques where appropriate, with the aim to reduce intra-operative and post-operative opiate use and the negative effects associated with these, encourage early mobilisation and improve patient experience.
Strategy for change
We retrospectively reviewed paediatric patients undergoing regional anaesthesia for elective and emergency orthopaedic procedures between May 2022 and October 2023. Data was collected from TRAK (paperless hospital record), and from scanned anaesthetic and drug charts. Pain scores, simple analgesia and opiate use up to 3 days post-operatively were reviewed and analysed.
Measure of improvement and lessons learnt
74 patients underwent regional anaesthesia during this time period with a total of 99 blocks and catheters being done (fig 1). 62% of patients had a block and 38% of patients had a catheter inserted. Catheters remained in for an average of 43 hours (range 8-71 hours). Opiate use increased post catheter removal, with an average of 0.115mg/kg/24hour whilst catheter remains in and 0.178mg/kg/24hr after removal. Average length of patient stay was 2 days (range 0-9). Of note 73% of patients had no intra-op opiate showing that opiate free anaesthesia is entirely possible with regional anaesthesia in orthopaedic surgery.
Message for others
We have shown that patients receiving regional anaesthesia for elective and emergency orthopaedic surgical procedures have low pain scores and low post-operative opiate use. Pain scores and opiate use with catheters is slightly higher however this may be a reflection of the fact that patients receiving catheters for post-operative analgesia are likely to be the patients that we would predict to have more pain in the post-operative period. Opiate use before and after catheter removal shows that these patients still have an increase in post-operative pain after the catheter is removed suggesting that opiate use would have otherwise been higher, and perhaps we should leave the catheter for slightly longer. Importantly there were no documented complications from any of these regional procedures showing that regional anaesthesia for paediatric orthopaedic patients is not only effective but safe.
References:
1- Dadure C et al. Epidemiology of regional anaesthesia in children: lessons learned from European Multi-institutional Study APRICOT. Pediatric Anesthesia 2019; 29: 1128-35
2- Pearson, A.M.E., Roberts, S. and Turbitt, L.R. (2023), New blocks on the kids: core basic nerve blocks in paediatric anaesthesia. Anaesthesia, 78: 3-8. https://doi.org/10.1111/anae.15876
3- Groenewald CB. Opioid-prescribing Patterns for Pediatric Patients in the United States. Clin J Pain. 2019 Jun;35(6):515-520. doi: 10.1097/AJP.0000000000000707. PMID: 30985396; PMCID: PMC6782052