Does ultrasound-guided popliteal-sciatic nerve block have superior pain control in pediatric foot and ankle surgery? A randomized control trial

Abstract

BackgroundTendon surgery in the pediatric foot and ankle could cause severe postoperative pain, which may lead to psychologic distress and chronic pain. This study was aimed to compare the efficacy of a peripheral nerve block (PNB) and local surgical site infiltration (LSI) in pediatric foot and ankle tendon surgery. MethodsForty pediatric patients, who underwent foot and ankle tendon surgery were enrolled. Patients age 1–6 years old were allocated to group 1 and 7–15 years old were group 2. The popliteal-sciatic nerve block with 0.5% Bupivacaine (0.25 ml/kg) for group 1A and 2A. Group 1B and 2B received 0.5% Bupivacaine (0.25 ml/kg) local injection before wound closure. Pain score was recorded using CHEOPS in 1–6 years (Group1A, 1B), NRS in age 7–15 years (Group 2A, 2B). The post-operative morphine consumption and complications were recorded. ResultsFor 7–15 years, pain score in group 2B was more than group 2A at postoperative 2 and 6 h [Mean difference (95% CI); -3.4 (-6.4 to -0.3), and -2 (-4.4 to 0.5), respectively], and reached MCID of 2. The number of morphine consumption was significantly higher in group 2 B at 0–6 and 6–12 h post-operatively [Mean difference (95% CI); -0.8 (-1.4 to -0.2), and -0.6 (-1.1 to -0.1), respectively, with p-value < 0.05]. For 1–6 years, there was no significant difference in pain score and number of postoperative morphine consumption. ConclusionsPNB and LSI provided effective pain management in patients aged 1–6 years old with no statistically significant difference. PNB showed significant superior pain control in patients aged 7–15 years old.