Management of the pain in patients with osteogenesis imperfecta during operations on the lower limb

Abstract

BACKGROUND: The method of choice for anesthetic support of orthopedic interventions for hip deformities in children is a combination of inhalation and prolonged epidural analgesia. Nevertheless, no consensus was found in the medical community about the advisable usage of neuraxial blockades in patients with osteogenesis imperfect (OI) due to the risk of hemorrhagic complications, as well as increased intracranial pressure against the background of hydrocephalus, as a manifestation of a craniocervical junction anomaly.
 AIM: To assess the efficacy and safety of prolonged epidural blockade as the main component of anesthesia and postoperative pain relief in children with OI during orthopedic correction of hip deformities.
 MATERIALS AND METHODS: A retrospective analysis from 2018 to 2020 included 40 children who underwent orthopedic interventions on the lower extremities. Considering a similar concomitant neurological pathology (epilepsy and hydrocephalus) and severity of hip surgical interventions, 2 groups of 20 persons were formed: the main group had OI and the control group had cerebral palsy (CP). The hemodynamic parameters, perioperative need for analgesics, volume of external blood loss and need for blood transfusion, and structure of complications were evaluated.
 RESULTS: Statistically significant differences were detected in hemodynamic parameters at the stage of tracheal intubation and the end of the surgery but without clinical significance, since they were within the acceptable physiological values. The recorded differences in the hemoglobin level of the capillary blood before the surgery are probably due to the initial hypovolemia and hemoconcentration in the CP group.
 CONCLUSIONS: Prolonged epidural analgesia in children with OI during orthopedic correction of hip deformities is an effective and safe component of anesthesia and postoperative pain relief.