Top

Published in:

01-12-2020 | Local Anesthesia in Dentistry | Original Article

The Utilization of Regional Anesthesia Among Pediatric Patients: A Retrospective Study

Authors: Kathryn DelPizzo, MD, Megan Fiasconaro, MS, Lauren A. Wilson, MPH, Jiabin Liu, MD PhD, Jashvant Poeran, MD PhD, Carrie Freeman, BS, Stavros G. Memtsoudis, MD, PhD, MBA, FCCP

Published in: HSS Journal ® | Special Issue 2/2020

Abstract

Background

The use of regional anesthesia (RA) in pediatric patients remains understudied, although evidence suggests benefits over general anesthesia.

Questions/Purposes

We sought to identify factors associated with RA use in patients under the age of 21 years undergoing ambulatory orthopedic surgery.

Methods

Patients under the age of 21 who underwent anterior cruciate ligament (ACL) repair or reconstruction, knee arthroscopy (KA), or shoulder arthroscopy (SA) were identified from the NY Statewide Planning and Research Cooperative System (SPARCS) database (2005–2015). Frequencies of RA use (defined by femoral nerve block, spinal, epidural, caudal, or brachial plexus anesthesia) were calculated. Multivariable regression analysis identified patient- and healthcare system–related factors associated with the use of RA. Odds ratios (OR) and 95% confidence intervals (CI) were reported.

Results

We identified 87,273 patients who underwent the procedures of interest (ACL n = 28,226; SA n = 18,155; KA n = 40,892). In our primary analysis, 14.4% (n = 1404) had RA as their primary anesthetic; this percentage increased for patients who had ACL or KA. When adjusting for covariates, Hispanic ethnicity (OR 0.78; CI 0.65–0.94) and Medicaid insurance (OR 0.75; CI 0.65–0.87) were associated with decreased odds for the provision of RA. Further, we identified increasing age (OR 1.10; CI 1.08–1.11), ACL versus SA (OR 1.91; CI 1.74–2.10), and sports injuries (OR 1.20; CI 1.10–1.31) as factors associated with increased odds of RA use.

Conclusion

In this analysis, RA was used in a minority of patients under the age of 21 undergoing ambulatory orthopedic surgery. Older age was associated with increased use while Hispanic ethnicity and lower socioeconomic status were associated with lower use.

Available only for authorised users

Austin PC. An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivar Behav Res. 2011;46:399-424. doi:https://doi.org/10.1080/00273171.2011.568786CrossRef

Beck NA, Ganley TJ. Pediatric ACL injuries: Challenges and solutions, from prevention to operative reconstruction. University of Pennsylvania Orthopaedic Journal. 2011;21:50-55. https://doi.org/10.1007/978-3-662-56127-0_17CrossRef

Chelly JE, Ben-David B, Williams BA, Kentor ML. Anesthesia and post-operative analgesia: Outcomes following orthopedic surgery. Orthopedics. 2003;26:S865-S871. https://doi.org/10.1111/os.12535CrossRefPubMed

Dodwell ER, LaMont LE, Green DW, Pan TJ, Marx RG, Lyman S. 20 years of pediatric anterior cruciate ligament reconstruction in New York state. Am J Sports Med. 2014;42:675-680. https://doi.org/10.1177/0363546513518412CrossRefPubMed

Iannotti JP. A delayed physical therapy protocol that limited passive range of motion was similar to a protocol with early passive range of motion after rotator cuff repair. J Bone Joint Surg Am. 2012;94:2094. https://doi.org/10.2106/JBJS.9422.ebo365CrossRefPubMed

Janssen R, Lind M, Engebretsen L, Moksnes H, Seil R, Faunø P, et al. Pediatric ACL injuries: treatment and challenges. In: ESSKA instructional course lecture book. Edited by Kerkhoffs GMMJ, Haddad F, Hirschmann MT, Karlsson J, Seil R: Berlin, Heidelberg, Springer. 2018, pp 241-259. https://doi.org/10.1007/978-3-662-56127-0_17

Mall NA, Paletta GA. Pediatric ACL injuries: Evaluation and management. Curr Rev Musculoskelet Med. 2013;6(2):132-140. https://doi.org/10.1007/s12178-013-9169-8CrossRefPubMedPubMedCentral

Memtsoudis SG, Poeran J, Zubizarreta N, Rasul R, Opperer M, Mazumdar M. Anesthetic care for orthopedic patients: Is there a potential for differences in care? Anesthesiology. 2016;124:608-623. https://doi.org/10.1097/ALN.0000000000001004CrossRefPubMed

Micalizzi RA, Williams LA, Pignataro S, Sethna NF, Zurakowski D. Review of outcomes in pediatric patients undergoing anterior cruciate ligament repairs with regional nerve blocks. J Pediatr Nurs. 2014;29:670-678. https://doi.org/10.1016/j.pedn.2014.07.002CrossRefPubMed

10.

Ochroch EA, Troxel AB, Frogel JK, Farrar JT. The influence of race and socioeconomic factors on patient acceptance of peri-operative epidural analgesia. Anesth Analg. 2007;105:1787-1792. https://doi.org/10.1213/01.ane.0000290339.76513.e3CrossRefPubMed

11.

Paul JE, Arya A, Hurlburt L, et al. Femoral nerve block improves analgesia outcomes after total knee arthroplasty: a meta-analysis of randomized controlled trials. Anesthesiology. 2010;113:1144-1162. https://doi.org/10.1097/MD.0000000000018056CrossRefPubMed

12.

Polaner DM, Martin LD, PRAN Investigators. Quality assurance and improvement: The pediatric regional anesthesia network. Paediatr Anaesth. 2012;22:115-119. https://doi.org/10.1111/j.1460-9592.2011.03708.xCrossRefPubMed

13.

Schloss B, Bhalla T, Klingele K, Phillips D, Prestwich B, Tobias JD. A retrospective review of femoral nerve block for post-operative analgesia after knee surgery in the pediatric population. J Pediatr Orthop. 2014;34:459-461. https://doi.org/10.1097/BPO.0000000000000113CrossRefPubMed

14.

Stracciolini A, Casciano R, Levey Friedman H, Meehan III WP, Micheli LJ. Pediatric sports injuries: An age comparison of children versus adolescents. Am J Sports Med. 2013;41:1922-1929. https://doi.org/10.1177/0363546513490644CrossRefPubMed

15.

Tepolt FA, Feldman L, Kocher MS. Trends in pediatric ACL reconstruction from the PHIS database. J Pediatr Orthop. 2018;38:e49-e494. https://doi.org/10.1097/BPO.0000000000001222CrossRef

16.

Walker BJ, Long JB, De Oliveria GS, et al. Peripheral nerve catheters in children: An analysis of safety and practice patterns from the pediatric regional anesthesia network (PRAN). Br J Anaesth. 2015;115:457-462. https://doi.org/10.1093/bja/aev220CrossRefPubMed

17.

Wardhan R, Chelly J. Recent advances in acute pain management: Understanding the mechanisms of acute pain, the prescription of opioids, and the role of multimodal pain therapy. F1000Res. 2017;6. https://doi.org/10.12688/f1000research.12286

18.

Werner BC, Yang S, Looney AM, Gwathmey FW. Trends in pediatric and adolescent anterior cruciate ligament injury and reconstruction. J Pediatr Orthop. 2016;36:447-452. https://doi.org/10.1097/BPO.0000000000000482CrossRefPubMed

19.

Veneziano G, Betran R, Bhalla T, Martin DP, Tobias JD. Peripheral regional anesthesia in infants and children: An update. Anaesth Pain Intensive Care. 2019;18:59-71. https://doi.org/10.1016/j.accpm.2019.02.011CrossRef

20.

Yang D, Dalton JE. A unified approach to measuring the effect size between two groups using SAS®. SAS Global Forum. 2012;335:1-6. https://support.sas.com/resources/papers/proceedings12/335-2012.pdf

Title: The Utilization of Regional Anesthesia Among Pediatric Patients: A Retrospective Study
Authors: Kathryn DelPizzo, MD
Megan Fiasconaro, MS
Lauren A. Wilson, MPH
Jiabin Liu, MD PhD
Jashvant Poeran, MD PhD
Carrie Freeman, BS
Stavros G. Memtsoudis, MD, PhD, MBA, FCCP
Publication date: 01-12-2020
Publisher: Springer US
Keywords: Local Anesthesia in Dentistry
Shoulder Arthroscopy
Arthroscopy
Arthroscopy of the Knee Joint
Arthroscopy
General Anesthesia
Published in: HSS Journal ® / Issue Special Issue 2/2020
Print ISSN: 1556-3316
Electronic ISSN: 1556-3324
DOI: https://doi.org/10.1007/s11420-020-09805-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The Utilization of Regional Anesthesia Among Pediatric Patients: A Retrospective Study

Abstract

Background

Questions/Purposes

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Questions/Purposes

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Special Issue 2/2020

Questioning the Clinical Relevance of Positive Post-implantation Allergy Testing for Metal Hypersensitivity in Total Knee Arthroplasty: A Didactic Case Report

ACL Reconstruction Graft Angle and Outcomes: Transtibial vs Anteromedial Reconstruction

Orthopedic Injuries Associated with Hoverboard Use in Children: A Multi-center Analysis

Certificate-of-Need Programs Are Associated with a Reduced Incidence, Expenditure, and Rate of Complications with Respect to Knee Arthroscopy in the Medicare Population

Monitoring Patient Recovery After THA or TKA Using Mobile Technology

Incidence of Surgically Treated Brachial Plexus Injury in Privately Insured Adults Under 65 Years of Age in the USA