Use of Epidural Analgesia in Children With Neuromuscular Conditions Following Hip Reconstruction

Sean Tabaie, Aribah Shah, Omar Tarawneh, Grace Blaylock, Evan Sheppard, Kevin Cho, Sean Tabaie, Aribah Shah, Omar Tarawneh, Grace Blaylock, Evan Sheppard, Kevin Cho

Abstract

Background: Neuromuscular conditions, such as cerebral palsy, are the most common motor disabilities in the pediatric population. Children with these conditions frequently have accompanying hip deformities that require pelvic and femur osteotomy to correct the spastic hip dislocations. However, postoperative pain management remains an elusive and challenging problem. The purpose of this study was to determine whether postoperative use of epidural analgesia in patients with neuromuscular conditions provided similar outcomes with regard to pain scores, length of stay, duration of foley placement, duration of pain control, and complications as compared to traditional pain management regimens. To our knowledge, this is the first study comparing the use of epidural analgesia to conventional pain relief modalities following hip reconstruction in patients with neuromuscular conditions.

Methods: A retrospective cohort study was performed using records of pediatric patients with neuromuscular conditions treated at our tertiary care center between January 2009 and December 2019. Patients with neuromuscular conditions treated with epidural or non-epidural analgesia for pain relief following unilateral or bilateral proximal femoral osteotomies, pelvic osteotomies, or open hip reduction were eligible for study inclusion. Multiple linear regression was used to determine differences in length of stay, pain score, pain modality, duration of Foley placement, and complications between the two cohorts.

Results: Seventy patients met the inclusion criteria for the study. In all, 58 patients underwent unilateral procedures, of which 30 (52%) received epidural analgesia, and 28 (48%) received non-epidural pain control modalities. Demographic and baseline characteristics were similar among the cohort, except for BMI, which varied slightly. Average pain scores and pain control duration were not statistically different between the pain control modalities. After controlling for demographics, procedure, and immobilization type, the epidural group experienced significantly increased length of stay (+3.18 days, P=0.032) and duration of Foley placement (+1.04 days, P=.013). Complication rates between the two groups were not statistically significant.

Conclusions: The use of epidural analgesia in children with neuromuscular conditions was associated with comparable pain scores, despite the increased length of stay and duration of Foley placement. No statistically significant difference in complication rates was observed between patients receiving epidural anesthesia and those receiving traditional pain modalities.

Keywords: cerebral palsy; complications; epidural analgesia; hip surgery; postoperative pain.

Conflict of interest statement

The authors have declared financial relationships, which are detailed in the next section.

Copyright © 2022, Tabaie et al.

References

    1. Cerebral palsy-trends in epidemiology and recent development in prenatal mechanisms of disease, treatment, and prevention. Stavsky M, Mor O, Mastrolia SA, Greenbaum S, Than NG, Erez O. Front Pediatr. 2017;5:21.
    1. Palliative hip surgery in severe cerebral palsy: a systematic review. Boldingh EJ, Bouwhuis CB, van der Heijden-Maessen HC, Bos CF, Lankhorst GJ. J Pediatr Orthop B. 2014;23:86–92.
    1. Hip pain in children with cerebral palsy: a population-based registry study of risk factors. Marcström A, Hägglund G, Alriksson-Schmidt AI. BMC Musculoskelet Disord. 2019;20:62.
    1. Hip displacement in cerebral palsy. Soo B, Howard JJ, Boyd RN, et al. J Bone Joint Surg Am. 2006;88:121–129.
    1. Pain assessment and treatment in children with significant impairment of the central nervous system. Hauer J, Houtrow AJ. Pediatrics. 2017;139
    1. Post-operative pain assessment and management in cerebral palsy (CP): a two-pronged comparative study on the experience of surgical patients. Xu N, Matsumoto H, Roye D, Hyman J. J Pediatr Nurs. 2019;46:0–4.
    1. Pain in children with cerebral palsy: a review. McKearnan KA, Kieckhefer GM, Engel JM, Jensen MP, Labyak S. J Neurosci Nurs. 2004;36:252–259.
    1. Peri-operative pain management in children with cerebral palsy: comparative efficacy of epidural vs systemic analgesia protocols. Moore RP, Wester T, Sunder R, Schrock C, Park TS. Paediatr Anaesth. 2013;23:720–725.
    1. Epidural analgesia is superior to local infiltration analgesia in children with cerebral palsy undergoing unilateral hip reconstruction. Kjeldgaard Pedersen L, Nikolajsen L, Rahbek O, Uldall Duch B, Møller-Madsen B. Acta Orthop. 2016;87:176–182.
    1. Postoperative epidural opioid analgesia: what are the choices? de Leon-Casasola OA, Lema MJ. Anesth Analg. 1996;83:867–875.
    1. Equivalence of postoperative analgesia with patient-controlled intravenous or epidural alfentanil. Chauvin M, Hongnat JM, Mourgeon E, Lebrault C, Bellenfant F, Alfonsi P. Anesth Analg. 1993;76:1251–1258.
    1. Epidural analgesia compared with intravenous analgesia after pediatric posterior spinal fusion. Gauger VT, Voepel-Lewis TD, Burke CN, Kostrzewa AJ, Caird MS, Wagner DS, Farley FA. J Pediatr Orthop. 2009;29:588–593.
    1. Analysis of length of hospital stay using electronic health records: a statistical and data mining approach. Baek H, Cho M, Kim S, Hwang H, Song M, Yoo S. PLoS One. 2018;13:0.
    1. Evaluation of hospital outcomes: the relation between length-of-stay, readmission, and mortality in a large international administrative database. Lingsma HF, Bottle A, Middleton S, Kievit J, Steyerberg EW, Marang-van de Mheen PJ. BMC Health Serv Res. 2018;18:116.
    1. Postoperative epidural analgesia versus systemic analgesia for thoraco-lumbar spine surgery in children. Guay J, Suresh S, Kopp S, Johnson RL. Cochrane Database Syst Rev. 2019;1:0.
    1. [The incidence of postoperative respiratory depression in patients undergoing intravenous or epidural analgesia with opioids] Duarte LT, Fernandes Mdo C, Costa VV, Saraiva RA. Rev Bras Anestesiol. 2009;59:409–420.
    1. Postoperative analgesia following surgical correction for adolescent idiopathic scoliosis: a comparison of continuous epidural analgesia and patient-controlled analgesia. Sucato DJ, Duey-Holtz A, Elerson E, Safavi F. Spine (Phila Pa 1976) 2005;30:211–217.
    1. Safety and efficacy of postoperative epidural analgesia. Wheatley RG, Schug SA, Watson D. Br J Anaesth. 2001;87:47–61.
    1. Hip reconstruction in nonambulatory children with cerebral palsy: identifying risk factors associated with postoperative complications and prolonged length of stay. Shea J, Nunally KD, Miller PE, Difazio R, Matheney TH, Snyder B, Shore BJ. J Pediatr Orthop. 2020;40:0–7.
    1. Indwelling catheter can increase postoperative urinary tract infection and may not be required in total joint arthroplasty: a meta-analysis of randomized controlled trial. Ma Y, Lu X. BMC Musculoskelet Disord. 2019;20:11.
    1. Catheter associated urinary tract infections. Nicolle LE. Antimicrob Resist Infect Control. 2014;3:23.
    1. Postoperative complications after hip surgery in patients with cerebral palsy: a retrospective matched cohort study. DiFazio R, Vessey JA, Miller P, Van Nostrand K, Snyder B. J Pediatr Orthop. 2016;36:56–62.
    1. High reoperation rates after early treatment of the subluxating hip in children with spastic cerebral palsy. Schmale GA, Eilert RE, Chang F, Seidel K. J Pediatr Orthop. 2006;26:617–623.

Source: PubMed

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