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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >NERVE BLOCKS FOR PEDIATRIC ACL RECONSTRUCTION: COMPARING FUNCTION, PATIENT-REPORTED OUTCOMES, AND EFFICIENCY
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NERVE BLOCKS FOR PEDIATRIC ACL RECONSTRUCTION: COMPARING FUNCTION, PATIENT-REPORTED OUTCOMES, AND EFFICIENCY

机译：儿科ACL重建神经障碍：比较功能，患者报告的结果和效率

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Background: Previous studies have compared the use of continuous nerve catheter versus single-shot nerve block approaches to regional anesthesia in ACL Reconstruction (ACLR), but they have primarily focused on adult populations. A paucity of data exists comparing these regional anesthesia techniques in children. Hypothesis/Purpose: To compare postoperative pain, strength, and functional outcomes between pediatric ACLR patients undergoing femoral nerve catheter (FNC) placement with single-shot sciatic block and those receiving femoral and sciatic single-shot nerve blocks (SSNB). Methods: Pediatric patients (≤18 years) undergoing primary ACLR between 1/2018-8/2019 at an urban tertiary care children’s hospital were identified. Patients were grouped based on regional anesthetic technique (FNC vs. SSNB). Emergency department (ED) visits, clinic visits, and calls for uncontrolled pain and narcotic refills were compared between these two groups. Outcomes including PROMIS scores, strength testing, and active range of motion (AROM) were also compared. Multiple imputation analysis was used to reduce bias as a result of missed follow-up. Results: 78 patients met inclusion criteria (FNC-36 patients, SSNB-42 patients). There were no differences in age, sex, BMI, or surgical technique between cohorts (Table I). Block preparation time (p&0.001) and surgical duration (p&0.001) were significantly longer for the FNC group. Ropivacaine dose (mg) of the sciatic nerve block was significantly higher in the SSNB group (35.0 ± 7.5 vs. 30.1 ± 4.1, p=0.001). All SSNB cases were performed at a satellite surgical center compared to 1 (2.8%) FNC case (p&0.001). There were no differences in uncontrolled pain or required narcotic refills between groups, and at 1 week follow-up, the proportion of patients with continued opioid consumption was not different (Table II). At 1 week, SSNB patients reported higher PROMIS physical function - mobility scores (25.5 ± 5.6 vs. 22.1 ± 4.9, p=0.009) with no difference in PROMIS pain interference scores. PROMIS scores were not different between cohorts at 6 weeks, 3 months or 6 months. AROM in extension and flexion also showed no difference between groups. SSNB was associated with a higher hamstrings to quadriceps ratio (quadriceps deficit) at 3 months (77.4 ± 23.8 vs. 66.2 ± 18.0, p=0.028), but there were no differences in isokinetic strength at 6 months. Conclusion: SSNB was associated with shorter operative times and better PROMIS physical function – mobility scores at 1 week compared to FNC. No other differences were observed in post-operative pain management, and cohorts were without differences in AROM and isokinetic strength by 6 months.
机译：背景：先前的研究已经比较了连续神经导管的使用与单次神经阻滞方式对ACL重建（ACLR）中的区域麻醉，但它们主要专注于成年人群。存在与儿童中的这些区域麻醉技术进行比较的缺乏数据。假设/目的：与单次坐骨嵌段进行股骨神经导管（FNC）放置的儿科ACLR患者之间的术后疼痛，强度和功能结果进行比较，以及接受股坐骨和坐标单次神经块（SSNB）。方法：确定了儿科患者（≤18岁）在城市第三级护理儿童医院达到2019年间接受的主要ACLR。患者基于区域麻醉技术（FNC与SSNB）进行分组。在这两组之间比较了急诊部门（ED）访问，诊所访问，呼吁不受控制的疼痛和麻醉素恢复。还比较了包括PROMIS评分，强度测试和主动运动范围（AROM）的结果。由于错过的随访，使用多重估算分析来减少偏差。结果：78名患者符合纳入标准（FNC-36患者，SSNB-42患者）。年龄，性别，BMI或群组之间的手术技术没有差异（表I）。嵌段制备时间（P＆amp; LT; 0.001）和外科手术持续时间（P＆amp; 0.001）对于FNC组显着更长。 SSNB组的坐骨神经嵌段的罗哌卡因剂量（Mg）显着较高（35.0±7.5 vs.3.1±4.1，p = 0.001）。与1（2.8％）FNC案例（P＆amp; 0.001）相比，在卫星手术中心进行所有SSNB病例。不受控制的疼痛或所需的麻醉剂在组之间没有差异，并且在1周随访时，持续的阿片类药物的患者的比例没有差异（表II）。在1周，SSNB患者报告了更高的PROMIS物理功能 - 移动分数（25.5±5.6与22.1±4.9，p = 0.009），销售痛苦分数没有差异。 6周或6个月的队列之间的伙伴分数与队列不同。延伸和屈曲的arom也没有在群体之间没有区别。 SSNB在3个月内与Quadriceps比（Quadriceps缺陷）的较高腿部（Quadriceps缺陷）相关联（77.4±23.8，P = 0.028），但在6个月内没有异动强度差异。结论：与FNC相比，SSNB与更短的操作时间和更好的PROMIS物理功能 - 移动性分数。在术后疼痛管理中没有观察到其他差异，并且队列在6个月内没有冒险和异动强度的差异。

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