Abstract
Background
Our objective was to evaluate national trends in regional anesthetic techniques among children undergoing ambulatory orthopedic procedures.
Purpose and Questions
We aimed to determine whether an increase in regional anesthetics was primarily driven by an increase in the number of peripheral nerve blocks performed rather than an increase in neuraxial techniques. We further aimed to determine whether the proportion of peripheral nerve blocks performed in conjunction with general anesthesia has increased over time.
Patients and Methods
Our study sample included any pediatric patient (i.e., <18 years old) who underwent an orthopedic ambulatory procedure in 1996 and 2006. We obtained data on ambulatory surgical procedures by accessing the Centers for Disease Control and Prevention’s National Survey of Ambulatory Surgery. Patient demographics (age, gender), procedure information, and anesthesia-related variables were analyzed for each year.
Results
The proportion of peripheral nerve blocks performed for ambulatory surgery more than doubled from 1996 (4.4 %) to 2006 (8.1 %). A significantly larger proportion of orthopedic procedures were being performed with a combination of peripheral nerve blocks and general anesthesia (1.2 % in 1996 and 43 % 2006). The use of neuraxial anesthesia for lower extremity surgeries decreased over the 10-year period (1.1 and 0.4 % in 1996 and 2006, respectively).
Conclusions
There was a significant increase in the use of peripheral nerve blocks for children undergoing ambulatory orthopedic procedures in the USA, while neuraxial techniques became less common over the 10-year period. The peripheral nerve blocks were frequently performed in conjunction with general anesthesia.
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References
DeVera et al. Regional techniques as an adjunct to general anesthesia for pediatric extremity and spine surgery. J Pediatr Orthop 2006; 26:801–4.
Ecoffey et al. Epidemiology and morbidity of regional anesthesia in children: a follow-up one-year prospective survey of the French-Language Society of Paediatric Anaesthesiologists (ADARPEF). Paediatr Anaesth 2010; 20: 1061–9.
Giaufre, et al. Epidemiology and morbidity of regional anesthesia in children: a one-year prospective survey of the French-Language Society of Pediatric Anesthesiologists. Anesth Analg 1996; 83: 904–12.
International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). CDC/National Center for Health Statistics, 2011. Web. 15 Aug 2011. http://www.cdc.gov/nchs/icd/icd9cm.htm.
Liu et al. A comparison of regional versus general anesthesia for ambulatory anesthesia: A meta-analysis of randomized controlled trials. Anesth Analg 2005; 101:1634–42.
Marhofer et al. Fifteen years of ultrasound guidance in regional anaesthesia: Part 1. BJA 2010; 104: 538–46.
Polaner et al. A1566: Pediatric Regional Anesthesia Network: The First 7500 Cases. ASA 2009 Annual Meeting.
Polaner et al. Quality assurance and improvement: the Pediatric Regional Anesthesia Network. Paediatr Anaesth 2012; 22: 115–9.
Rabbitts et al. Epidemiology of ambulatory anesthesia for children in the United States; 2006 and 1996. Anesth Analg 2010; 111:1011–15.
Rappaport et al. Defining safe use of anesthesia in children. NEJM 2011; 364: 1387–90.
Tsui, B and Suresh S. Ultrasound imaging for regional anesthesia in infants, children, and adolescents. Reg Anesth Pain Med 2010; 35: S47-S54.
Wong et al. Spinal anesthesia improves the early recovery profile of patients undergoing ambulatory knee arthroscopy. Can J Anaesth 2001; 48: 369–74.
Acknowledgment
Madhu Mazumdar, PhD, received funding from the NIH for a portion of the work.
Disclosures
Each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.
Each author certifies that his or her institution has waived the requirement for informed consent for this investigation and that all investigations were conducted in conformity with ethical principles of research.
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Level of Evidence: Therapeutic Study: Level IV. See “Levels of Evidence” for a complete description.
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Kuo, C., Edwards, A., Mazumdar, M. et al. Regional Anesthesia for Children Undergoing Orthopedic Ambulatory Surgeries in the United States, 1996–2006. HSS Jrnl 8, 133–136 (2012). https://doi.org/10.1007/s11420-012-9278-8
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DOI: https://doi.org/10.1007/s11420-012-9278-8