It was not so long ago that the first description of home discharge with a continuous peripheral nerve block (CPNB) catheter was published. I remember wondering can’t the same thing be done in children? Well, now it can be done. Dr. Harshad Gurnaney, Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia and Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA and coauthors describe the use of CPNBs at The Children’s Hospital of Philadelphia for 1700 children and adolescents undergoing orthopedic surgery between January 1, 2005, and December 31, 2011. Their findings will appear in the article “Ambulatory Continuous Peripheral Nerve Blocks in Children and Adolescents: A Longitudinal 8-Year Single Center Study,” which will be published in a future issue of Anesthesia & Analgesia.
The average age was 14 years. The majority of patients had catheters inserted after the induction of anesthesia. Full barrier protection was used for the insertion of all catheters. For the majority of patients, nerve stimulation and ultrasound guidance were both used. A continuous infusion of either bupivacaine or ropivacaine was given postoperatively, though ropivacaine was the anesthetic of choice after August 2006. A lower concentration of local anesthetic was used for sciatic blocks (ropivacaine 0.1% and 0.13%) whereas a higher concentration of local anesthetics was used for femoral, infraclavicular, and interscalene blocks (ropivacaine 0.2% and bupivacaine 0.125%). The infusion rate was based on catheter location and patient weight. Parents received verbal and written instructions concerning the continuous infusion device system, how to remove the catheter, and how to recognize complications. Parents were also given phone numbers to call in order to contact the pain service. Patients were followed by phone up to twice daily until the sensory block had resolved and until there were no side effects.
Approximately 1300 patients were discharged home with catheters. The average time the catheters remained in was 51 hours. Over the course of the 5 year study period the number of children and adolescents discharged home with continuous peripheral nerve blocks increased about 80%. Most patients were discharged home within 24 hours after surgery (about 35% on the day of surgery and about 55% on the first postoperative day). Of patients discharged home on the day of surgery, about 64% of patients with interscalene catheters were discharged home compared with the 35% of patients who had femoral catheters. Fifteen patients could not be contacted at home following discharge. All were later seen in the surgical office, and none reported any problems related to the catheters. Sixty-four patients had complications; they are described in more detail in the article.
This report is encouraging: children can return home earlier after major orthopedic surgery when discharged with continuous peripheral nerve blocks.