Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Aug;32(8):946-953.
doi: 10.1111/pan.14468. Epub 2022 May 1.

Pediatric lower limb peripheral nerve blocks: Indications, effectiveness, and the incidence of adverse events

Geoff Frawley  1   2   3 , Vanessa Marchesini  1 , Brian Loh  4   5 , James Koziol  1
Affiliations

Pediatric lower limb peripheral nerve blocks: Indications, effectiveness, and the incidence of adverse events

Geoff Frawley et al. Paediatr Anaesth. 2022 Aug.

Abstract

Aim: While the proportion of pediatric anesthetics with regional anesthesia in pediatric patients has steadily increased, there are only a few series that describe the use of lower limb peripheral nerve blocks in children. Our aim was to describe the indications, anesthetic approach, and complications associated with lower limb blocks in children undergoing orthopedic surgery in a center with a large caseload of complex patients.

Methods: In a retrospective analysis of prospectively collected data, we reviewed children who had a peripheral nerve block for orthopedic surgery placed between January 2016 and January 2021 at the Royal Children's Hospital Melbourne. Block data were sourced from the electronic medical record and departmental regional anesthesia database. Data collected included demographics, the site of catheter placement and technique of nerve block, presence of sensory/motor blockade, the use of perioperative opioids, and any complications related to peripheral nerve block.

Results: A total of 1438 blocks were performed in 1058 patients. Four patients had clinical features of perioperative neurological injury giving an incidence of 3 per 1000 blocks (95% CI 1.1-8:1000). Only one patient had a sensory deficit persisting longer than 6 months for an incidence of 0.8 per 1000 blocks (95% CI 0.1-5:1000). All four peripheral nerve injury followed tibial osteotomy for lengthening procedures or correction of tibial torsion. The etiology of the injury could not be determined despite imaging and surgical exploration and the contribution of popliteal sciatic nerve block to the subsequent PNI could not be confirmed. There were no cases of local anesthetic systemic toxicity.

Conclusion: An increased risk of perioperative peripheral nerve injury is associated with pediatric tibial osteotomy for congenital deformity. While popliteal sciatic nerve block was not directly implicated in the nerve injury the presence of a prolonged sensory block can delay early recognition and treatment of peripheral nerve injury.

Keywords: anesthesia; complication; local; nerve block; postoperative.

PubMed Disclaimer

References

REFERENCES

    1. Rochette A, Dadure C, Raux O, et al. A review of pediatric regional anesthesia practice during a 17-year period in a single institution. Paediatr Anaesth. 2007;17:874-880.
    1. Polaner DM, Taenzer AH, Walker BJ, et al. Pediatric regional anesthesia network (PRAN): a multi-institutional study of the use and incidence of complications of pediatric regional anesthesia. Anesth Analg. 2012;115:1353-1364.
    1. Ecoffey C, Lacroix F, Giaufre E, 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;20:1061-1069.
    1. Walker BJ, Long JB, Sathyamoorthy M, et al. Complications in pediatric regional anesthesia: an analysis of more than 100,000 blocks from the pediatric regional anesthesia network. Anesthesiology. 2018;129:721-732.
    1. Kuo C, Edwards A, Mazumdar M, Memtsoudis SG. Regional anesthesia for children undergoing orthopedic ambulatory surgeries in the United States, 1996-2006. HSS J. 2012;8:133-136.

LinkOut - more resources