Abstract
Purpose
The aim of this study was to evaluate the effects of a preoperative popliteal block on sevoflurane consumption, postoperative pain, and analgesic consumption in children with cerebral palsy (CP) following lower limb surgery.
Methods
Fifty-four patients undergoing lower limb surgery were randomized to receive either a popliteal block + general anaesthesia (group P, n = 27) or general anaesthesia without a popliteal block (group C, n = 27). After anesthesia induction with 50% N2O, O2, and 8% sevoflurane, a popliteal block was given to group P patients with ultrasound guidance as a single dose of 0.3 ml/kg body weight of 0.25% bupivacaine. Group C patients received the same regimen of anesthesia induction but no preoperative popliteal block. Both the conductance fluctuation (SCF) peak numbers per second and the Wong–Baker FACES® Pain Rating Scale (WBFS) values of the patients were recorded upon arrival at the PACU, at 10 and 20 min after arrival at the PACU, and at postoperative hours 1, 4, 8, 12, and 24 when they were in the ward. The total paracetamol consumption of the patients was also recorded.
Results
The end-tidal sevoflurane concentration values were significantly higher in group C patients than in group P patients, except for at 5 min after induction of anaesthesia (p < 0.001). The SCF peak numbers per second and WBFS scores were significantly higher in group C patients than in group P patients, except at Tp24h (p < 0.001). The total paracetamol consumption was 489.7 ± 122.7 mg in group P patients and 816.6 ± 166.5 in group C patients (p < 0.001).
Conclusion
Popliteal block is effective for postoperative analgesia, decreasing the paracetamol consumption and sevoflurane requirement in children with CP undergoing lower limb surgery.
Trial registration ClinicalTrial.gov identifier: NCT02507700.
Similar content being viewed by others
References
Nolan J, Chalkiadis GA, Low J, Olesch CA, Brown TC. Anaesthesia and pain management in cerebral palsy. Anaesthesia. 2000;55:32–41.
Nemeth BA, Montero RJ, Halanski MA, Noonan KJ. Epidural Baclofen for the management of postoperative pain in children with cerebral palsy. J Pediatr Orthop. 2015;35(6):571–5.
Shrader MW, Jones J, Falk MN, White GR, Burk DR, Segal LS. Hip reconstruction is more painful than spine fusion in children with cerebral palsy. J Child Orthop. 2015;9(3):221–5.
Petroheilou K, Livanios S, Zavras N, Hager J, Fassoulaki A. Sciatic lateral popliteal block with clonidine alone or clonidine plus 0.2% ropivacaine: effect on the intra-and postoperative analgesia for lower extremity surgery in children: a randomized prospective controlled study. BMC Anesthesiol. 2012;12:2.
Drendel AL, Kelly BT, Ali S. Pain assessment for children: overcoming challenges and optimizing care. Pediatr Emerg Care. 2011;27:773–81.
Storm H. Changes in skin conductance as a tool to monitor nociceptive stimulation and pain. Curr Opin Anaesthesiol. 2008;21:796–804.
Ledowski T, Bromilow J, Wu J, Paech MJ, Storm H, Schug SA. The assessment of postoperative pain by monitoring skin conductance: results of a prospective study. Anaesthesia. 2007;62:989–93.
Hagbarth KE, Hallin RG, Hongell A, Torebjörk HE, Wallin BG. General characteristics of sympathetic activity in human skin nerves. Acta Physiol Scand. 1972;84:164–76.
Wong DL, Baker CM. Pain in children: comparison of assessment scales. Okla Nurse. 1988;33:8.
Buys MJ, Arndt CD, Vagh F, Hoard A, Gerstein N. Ultrasound-guided sciatic nerve block in the popliteal fossa using a lateral approach: onset time comparing separate tibial and common peroneal nerve injections versus injecting proximal to the bifurcation. Anesth Analg. 2010;110:635–7.
Aldrete JA. The post-anesthesia recovery score revisited. J Clin Anesth. 1995;7:89–91.
Maranhao MVM. Anesthesia and cerebral palsy. Rev Bras Anestesiol. 2005;55(6):680–702.
Capjon H, Bjørk IT. Ambulant children with spastic cerebral palsy and their parents’ perceptions and expectations prior to multilevel surgery. Dev Neurorehabil. 2010;13(2):80–7.
Nielsen DM, Gill K, Ricketts DM. Satisfaction levels in orthopaedic out-patients. Ann R Coll Surg Engl. 2005;87(2):106–8.
Collignon P, Giusiano B. Validation of a pain evaluation scale for patients with severe cerebral palsy. Eur J Pain. 2001;5:433–42.
Breau LM, Camfield CS, McGrath PJ, Finley GA. The incidence of pain in children with severe cognitive impairments. Arch Pediatr Adolesc Med. 2003;157:1219–26.
Russo RN, Miller MD, Haan E, Cameron ID, Crotty M. Pain characteristics and their association with quality of life and self-concept in children with hemiplegic cerebral palsy identified from a population register. Clin J Pain. 2008;24(4):335–42.
Oberlander TF, O’Donnell ME, Montgomery CJ. Pain in children with significant neurological impairment. J Dev Behav Pediatr. 1999;20:235–43.
Chou R, Gordon DB, de Leon-Casasola OA, Rosenberg JM, Bickler S, Brennan T, Carter T, Cassidy CL, Chittenden EH, Degenhardt E, Griffith S, Manworren R, McCarberg B, Montgomery R, Murphy J, Perkal MF, Suresh S, Sluka K, Strassels S, Thirlby R, Viscusi E, Walco GA, Warner L, Weisman SJ, Wu CL. Management of postoperative pain: a Clinical Practice Guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists’ Committee on Regional Anesthesia, Executive Committee, and Administrative Council. J Pain. 2016;17(2):131–57.
Jabbari B. Botilinum toxins for treatment of pain in orthopedic disorders. In: Jabbary B, editor. Botilinum toxin treatment of pain disorders. New York: Springer Science+Business Media; 2015. p. 193–204.
Barwood S, Baillieu C, Boyd R, Brereton K, Low J, Nattrass G, Graham HK. Analgesic effects of botulinum toxin A: a randomized, placebo-controlled clinical trial. Dev Med Child Neurol. 2000;42:116–21.
Oberndorfer U, Marhofer P, Bösenberg A, Willschke H, Felfernig M, Weintraud M, Kapral S, Kettner SC. Ultrasonographic guidance for sciatic and femoral nevre blocks in children. Br J Anaesth. 2007;98:797–801.
Lewis SR, Price A, Walker KJ, McGrattan K, Smith AF. Ultrasound guidance for upper and lower limb blocks. Cochrane Database Syst Rev. 2015;11:CD006459.
Bosenberg A, Thomas J, Lopez T, Kokinsky E, Larsson LE. Validation of a six-graded faces scale for evaluation of postoperative pain in children. Paediatr Anaesth. 2003;13:708–13.
Guignard B. Monitoring analgesia. Best Pract Res Clin Anaesthesiol. 2006;20:161–80.
Storm H, Shafiei M, Myre K, Raeder J. Palmar skin conductance compared to a developed stress score and to noxious and awakening stimuli on patients in anaesthesia. Acta Anaesthesiol Scand. 2005;49:798–803.
Choo EK, Magruder W, Montgomery CJ, Lim J, Brant R, Ansermino JM. Skin conductance fluctuations correlate poorly with postoperative self-report pain measures in school-aged children. Anesthesiology. 2010;113:175–82.
Hullett B, Chambers N, Preuss J, Zamudio I, Lange J, Pascoe E, Ledowski T. Monitoring electrical skin conductance: a tool for the assessment of postoperative pain in children? Anesthesiology. 2009;111:513–7.
Kim SH, Chun DH, Chang CH, Kim TW, Kim YM, Shin YS. Effect of caudal block on sevoflurane requirement for lower limb surgery in children with cerebral palsy. Paediatr Anaesth. 2011;21:394–8.
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Ozkan, D., Gonen, E., Akkaya, T. et al. Popliteal block for lower limb surgery in children with cerebral palsy: effect on sevoflurane consumption and postoperative pain (a randomized, double-blinded, controlled trial). J Anesth 31, 358–364 (2017). https://doi.org/10.1007/s00540-017-2318-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00540-017-2318-2