Ultrasound-Guided Comparison of Psoas Compartment Block and Supra-Inguinal Fascia Iliaca Compartment Block for Pain Management in Pediatric Developmental Dysplasia of Hip Surgeries.

Junjun Quan,Kai Chen,Yuchao Chen,Siyuan Yu,Shujun Yang

doi:10.3389/fped.2021.801409

Abstract

BackgroundThe aim of this study was to compare psoas compartment block (PCB) and supra-inguinal fascia iliaca compartment block (SFIB) in terms of pain management and the need for additional systemic analgesia in the perioperative phase of developmental dysplasia of the hip (DDH).Materials and MethodsSixty pediatric patients were randomized into the PCB group and the SFIB group. The Numeric Rating Scale (NRS) pain scores were used to assess postoperative pain during the initial 24 h after extubation. Sufentanil consumption, patient-controlled analgesia (PCA) demands, and complications were also recorded.ResultsThe NRS pain scores were significantly lower in the PCB group than in the SFIB group at 0, 4, 8, 12, and 24 h after extubation (all P < 0.01). Postoperatively, 13.8% of patients in the PCB cohort received additional administration of sufentanil, in contrast to 63.3% of the SFIB cohort (P < 0.01). In the PCB group, 0 (0-0) mcg/kg sufentanil was administered, while in the SFIB group 0.1 (0-0.2) mcg/kg (P < 0.01). In addition, the PCB group had fewer PCA demands than the SFIB group within the initial 24 h (P < 0.01). It took less operating time to achieve SFIB as compared to PCB (P < 0.01). No adverse events related to two techniques were recorded.ConclusionsPCB provided a better perioperative pain management in pediatric patients with the DDH surgeries compared to SFIB. It also reduced the need for supplementary systemic analgesia.

Highlights

Perioperative pain management of patients undergoing surgeries for developmental dysplasia of the hip (DDH) is a challenging issue for anesthesiologists
The Numeric Rating Scale (NRS) pain scores were significantly lower in the Psoas compartment block (PCB) group than in the supra-inguinal fascia iliaca compartment block (SFIB) group at 0, 4, 8, 12, and 24 h after extubation
PCB provided a better perioperative pain management in pediatric patients with the DDH surgeries compared to SFIB

Summary

Introduction

Perioperative pain management of patients undergoing surgeries for developmental dysplasia of the hip (DDH) is a challenging issue for anesthesiologists. The pediatric patients with DDH at late stage and concomitant hip pathology or other related abnormities maybe only receive orthopedic surgeries such as acetabuloplasty combined with femoral osteotomy (1) This surgical approach involves a large area of tissues innervated mostly by the lumbosacral plexus (2), for older children with unilateral hip and femoral surgeries, regional block has become a promising and advantageous analgesic technique in perioperative pain management (3). The spread potentially improves the success of lateral femoral cutaneous nerve block when compared with the inferior-inguinal fascia iliaca compartment block and has already shown its strength in adult hip and femur surgeries (7, 8) Soft tissue connections such as nerve sheath and aponeurosis are looser in children compared to adults, which favors the diffusion of local anesthetics and produces easier block of the distal nerve fibers. The aim of this study was to compare psoas compartment block (PCB) and supra-inguinal fascia iliaca compartment block (SFIB) in terms of pain management and the need for additional systemic analgesia in the perioperative phase of developmental dysplasia of the hip (DDH)

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