Pediatric Hip Surgery Research Articles

Ultrasound guided pericapsular nerve group block and fascia iliaca block in pediatric hip surgery

Ultrasound guided pericapsular nerve group block and fascia iliaca block in pediatric hip surgery

Regional anesthesia for hip surgery in children: A review

Hip joint diseases are one of the most common and difficult problems in pediatric orthopedics, often requiring surgical treatment. In children, intra- and postoperative analgesia after hip surgery is more conservative and limited to epidural anesthesia, which has known disadvantages and limitations, despite the high quality of pain relief. Peripheral regional blocks in hip surgery are widespread in adults. Ultrasound navigation makes peripheral blockades safer and more effective. This largely influenced the spread of their use in children and contributed to the introduction of new methods of planar blockades into practice. The authors analyzed studies on the efficacy and safety of modern methods of peripheral regional blockade used in children during hip surgery. The literature search was conducted in the eLibrary, PubMed, and Scopus databases. By using keywords, 750 literature sources were found, and 65 sources relevant to the purpose of the study were included in the review. The lumbar plexus block and fascia iliaca block are the most studied regional techniques in children, which are not inferior in analgesic efficacy to lumbar epidural and caudal anesthesia. A new and promising method of regional anesthesia of the hip is the pericapsular nerve group block, which has been well studied in adults. However, none of the peripheral regional techniques used for analgesia after hip surgery, has not proven its advantages. Further clinical studies are needed to investigate peripheral regional anesthesia techniques and determine their efficacy and safety in pediatric hip surgery.

Comparison of conventional caudal block, ultrasound guided caudal block and ultrasound guided erector spinae block for pediatric hip surgery: A randomized double blinded study

Comparison of conventional caudal block, ultrasound guided caudal block and ultrasound guided erector spinae block for pediatric hip surgery: A randomized double blinded study

Effect of erector spinae plane block on postoperative analgesia after pediatric hip surgery: Randomized controlled study.

Erector spinae plane block (ESPB) in pediatric patients presenting for hip surgery may improve the postoperative analgesia. The study aimed to investigate the effect of ultrasound-guided ESPB on postoperative analgesia after a pediatric hip surgery. Forty children scheduled for hip surgeries were included in this trial and randomly distributed into; Control group, patients received sham ultrasound-guided ESPB at the level of L3 or ESPB group, patients received real ultrasound-guided ESPB at the level of L3 with an injection of 0.4ml/kg of plain bupivacaine 0.25%. The time for the first call of rescue analgesia, intraoperative fentanyl consumption, postoperative morphine consumption, Children's Hospital Eastern Ontario Pain Scale (CHEOPS), and Objective Behavioral Pain score (OPS) were recorded. As compared to the control group, the use of ESPB significantly prolonged the time for first request of rescue analgesia from 170.50±44.066 to 256.50±66.434min (p<0.0001), decreased the intraoperative fentanyl consumption from 1.025±0.379 to 0.775±0.343μg/kg (p=0.035), decreased the postoperative morphine consumption from 0.105±0.036 to 0.065±0.023mg/kg (p=0.0002). Also, it significantly decreased postoperative CHEOPS and OPS scores 2, 4, and 6h after the surgery (p<0.05) with an insignificant difference between the two groups at all other time intervals (p˃0.05). The use of ESPB in pediatric patients undergoing hip surgery prolonged the time for the first call of analgesia, decreased the intraoperative and postoperative opioid consumption, and decreased the postoperative pain.

No Difference in the Incidence of Complications in Pediatric Patients with Moderate Anemia 30 Days after Pediatric Hip Surgery with and without Blood Transfusion.

This study investigated the association between postoperative blood transfusion and the incidence of postoperative complications 30 days after pediatric hip surgery as well as factors significantly associated with 30-day postoperative complications. Patients were divided into two groups: those with postoperative complications and those with no complications. Postoperative hematocrit (Hct) was categorized as <25%, 25–30%, and >30%. Comparison was made between all postoperative complications at the 30-day follow-up that were influenced by anemia in patients who received transfusion and those who did not. A multivariate logistic regression model was used to identify factors independently associated with postoperative complications. The overall 30-day postoperative complication rate for all patients was 17% (24/138). No significant difference between the transfusion and the non-transfusion patients was found. Preoperative hematocrit (Hct) was significantly lower in the complications group (p = 0.030), and both length of stay and 30-day readmission were significantly higher in patients with complications (p = 0.011 and p < 0.001, respectively). Multivariate analysis revealed female gender (OR: 3.50, 95% CI: 1.18–10.36; p = 0.026) and length of hospital stay (OR: 1.23, 95% CI: 1.08–1.41; p = 0.004) to be factors independently associated with 30-day postoperative complications. However, no statistically significant difference in the incidence of complications at 30 days following pediatric hip dysplasia surgery was found between patients who received blood transfusion to maintain a Hct level ≥25% and those not receiving transfusion.

Effect of ultrasound-guided lumbar plexus block on emergence agitation in children undergoing hip surgery: study protocol for a randomized controlled trial

BackgroundEmergence agitation (EA) is a common postoperative issue in children that causes self-injury, increases stress on healthcare team members, and even leads to postoperative maladaptive behavioral changes in children. Clear answers regarding a ‘gold standard’ for prevention of EA are not available. Pain is regarded as an important causative factor of EA, and ultrasound-guided lumbar plexus block is a safe and efficient anesthetic method that can provide satisfactory pain relief in pediatric hip surgery. The purpose of our study is to determine whether ultrasound-guided lumbar plexus block can reduce the incidence of EA in children undergoing hip surgery.Methods/designWe designed a prospective, randomized, controlled, blinded trial to determine the effect of ultrasound-guided lumbar plexus block on EA. A total of 100 American Society of Anesthesiologists class I–II children (1–6 years old) scheduled for elective hip surgery will be recruited for this study. Participants will be randomized at a 1:1 ratio to receive either ultrasound-guided lumbar plexus block or fentanyl after the induction of general anesthesia. The primary outcome is the incidence of EA 30 min after emergence from anesthesia using the Pediatric Anesthesia Emergence Delirium (PAED) score. The secondary outcomes are the severity and duration of EA 30 min after emergence from anesthesia using the PAED score, postoperative pain evaluated by the Children’s Hospital of Eastern Ontario Pain Scale, and the incidence of postoperative adverse events. Randomization will be conducted using a computer-generated randomization schedule. Outcome assessors and data collectors will be blinded to the group allocations. Assessments will be performed before surgery, intraoperatively, and postoperatively at every time point.DiscussionOur hypothesis in this trial is that ultrasound-guided lumbar plexus block can decrease the incidence of EA in children undergoing elective hip surgery. This trial will provide clinical answers to verify our hypothesis. If our hypothesis is confirmed, the results could provide a safe method to prevent EA.Trial registrationChinese Clinical Trial Registry, ChiCTR-INR-17011525. Registered on 30 May 2017.

Erector spinae plane block for pediatric hip surgery -a case report-

Surgical repair of the hip is considered an extremely painful procedure. Managing pain in this surgery is challenging even with several available options, each with limitations. Erector spinae plane (ESP) block is a novel technique that has been used in different types of surgery, with promising results. Herein, we describe a case of a successful ESP block for pediatric hip surgery. In the future, ESP block could be an alternative technique for providing effective analgesia.

Comparative Effects of Standard and Bipolar Cauterization in Pediatric Orthopedic Surgery

Background: One of the most important issues in the orthopedic surgery, especially pediatric orthopedic surgery, is to prevent or reduce bleeding during the operating time. The goal of local hemostasis is to prevent or blockade the flow of blood from a disrupted vessel that has been incised or transected.Objectives: The aim of this study was to compare the effects of standard (monopolar) and bipolar electrocauterization during the pediatric orthopedic surgery.Methods: In this study, 60 patients were enrolled for the pediatric orthopedic surgery and classified into two groups. Group I included 30 patients undergoing hemostasis with standard electrocautery and group II comprised 30 patients undergoing hemostasis with bipolar electrocautery. The intraoperative bleeding was measured with sterile absorbent gauze. Every gauze could absorb 20 mL of blood. Then, bleeding was compared between the groups.Results: The average amount of blood loss and operating time was 134.6 ± 0.04 mL and 140.9 ± 0.02 minutes in group I and 133.4 ± 0.07 mL and 140.2 ± 5 minutes in group II, respectively. Thus, there was no significant difference between the two groups (P = 0.65 and 0.70, respectively).Conclusions: There was no significant difference in blood loss and operating time between patients in groups I and II. Therefore, the use of monopolar and bipolar cauterization in the pediatric hip surgery has the same effects on blood loss and operating time.

A modification of ultrasound with nerve stimulation‐guided lumbar plexus block in supine position for pediatric hip surgery

A modification of ultrasound with nerve stimulation‐guided lumbar plexus block in supine position for pediatric hip surgery

A Long-term Retrospective Evaluation of Functional and Radiographic Outcomes of Pediatric Hip Surgery in Hurler Syndrome.

After successful hematopoietic stem cell transplantation, maintaining function and mobility have become key goals in the management of patients with Hurler syndrome, (mucopolysaccharoidosis type 1H). The aim of this study was to establish the functional and radiologic outcomes after hip surgery in patients with this condition who had reached skeletal maturity. We prospectively followed 13 mucopolysaccharoidosis type 1H patients with closed triradiate cartilages who had undergone hip surgery in a single institution (Our Lady's Children's Hospital, Crumlin) in early childhood, after successful hematopoietic stem cell transplantation. Functional assessment was performed using the Harris Hip Score. Acetabular and femoral head morphology were defined using a pelvic radiograph. The average age at follow-up was 18.6 years (range, 13.2 to 23.8 y). The average length of follow-up from surgical intervention was 14.6 years (range, 10.3 to 21.6 y). The average Harris Hip Score at follow-up was 61.0 (range, 19 to 91). At follow-up, 4 patients were either wheelchair bound or required a walking frame to mobilize in the community. At follow-up, all hips were in-joint with an average center edge angle of 37.7 degrees (range, 0 to 63 degrees). All hips displayed characteristic medial flattening of the femoral head. Ten hips (of 26 hips) showed radiologic degenerative changes with loss of joint space <2 mm. Despite the surgical provision of stable well-covered hips, active intervention did not prevent the development of radiologic deterioration and clinically significant hip arthritis. We recommend that pediatric hip surgery in Hurler syndrome be designed with the possibility of early hip replacement in mind. Level III.

Sports participation amongst children treated with the Ponseti method for Idiopathic Congenital Talipes Equinovarus

At follow up, 4 patients were either wheelchair bound or required a walking frame to mobilize in the community. At follow up, all hips were in-joint. All hips displayed characteristic medial flattening of the femoral head. Ten hips (of 26 hips) showed radiological degenerative changes with loss of joint space < 2mm. Conclusion(s): This is the first study to report both longterm functional and radiological outcomes in this population. Despite the surgical provision of stable well-covered hips, active intervention did not prevent the development of radiological deterioration and clinically significant hip arthritis. The authors recommend that pediatric hip surgery in Hurler syndrome is designedwith the possibility of early hip replacement in mind. Implications: The lifespan and long-term functional requirements of children with MPS-1 are unknown. HSCT has revolutionized the care of children with MPS-1. However HSCT has presented health professionals treating these patients with a challenge, in that the natural history of the musculoskeletal aspects of this condition post HSCT is entirely unknown. The authors have found that achieving good radiological correction of hip dysplasia in patients did not prevent these patients from developing clinically significant arthritis in young adulthood. Recommendations are that the outcomes of all children internationally (both operatively and non-operatively treated) be pooled to facilitate a greater understanding of both the natural history and results of interventions in this rare metabolic disorder.

A long-term retrospective evaluation of functional outcomes of pediatric hip surgery in patients with Hurler syndrome

A long-term retrospective evaluation of functional outcomes of pediatric hip surgery in patients with Hurler syndrome

Mean 5-Year Clinical and Radiographic Outcomes of Cementless Total Hip Arthroplasty in Patients under the Age of 30

We performed a retrospective review of 40 consecutive modern cementless THAs with 65-month mean followup in 34 patients under the age of 30 primarily for diagnoses other than inflammatory arthritis. We found acceptable functional improvement and radiographic outcomes at mean 5-year followup. We found a high transfusion rate, dislocation rate (10%), and midterm overall aseptic revision rate (17%). Twenty-eight (67.5%) of hips in this series were metal on metal, with a large percentage of aseptic revisions related to metallosis (57%). When revisions due to metallosis were excluded, the aseptic revision rate was 7.5%. The high prevalence of prior pediatric hip surgery in these patients (50%) may predispose to increased technical difficulty resulting in increased complications and higher revision rates. Although our revision rate was high in these young patients, it is favorable compared to older techniques and consistent with the limited data available with modern cementless techniques in patients of similar age. Cementless THA with modern designs remains a viable option for the treatment of arthritis in the young patient.

Radiodense lines and subclinical infection in pediatric hip surgery.

A subtle radiolucency with surrounding sclerosis was seen in 14 of 129 hip implant removals in 90 children. Five of these implants were cultured, and all five grew Staphylococcus epidermidis. The other nine were not cultured. None of the 14 had sequela. These radiographic findings should prompt suspicion of infection even in the absence of clinical or laboratory findings; they should also prompt hardware removal.

小児股関節手術における低血圧麻酔の有用性について

小児股関節手術における低血圧麻酔の有用性について

Perthes' disease. Treatment with the Birmingham splint.

The Journal of Bone and Joint Surgery. British volumeVol. 64-B, No. 1 ArticlesFree AccessPerthes' disease. Treatment with the Birmingham splintMH Harrison, MH Turner, DN SmithMH HarrisonSearch for more papers by this author, MH TurnerSearch for more papers by this author, DN SmithSearch for more papers by this authorPublished Online:1 Feb 1982https://doi.org/10.1302/0301-620X.64B1.7068716AboutSectionsPDF/EPUB ToolsAdd to FavouritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetailsCited BySurgical Treatments for Legg-Calvé-Perthes Disease: Comprehensive Review3 May 2021 | Interactive Journal of Medical Research, Vol. 10, No. 2Legg-Calvé-Perthes Disease26 February 2019The History of Pediatric Hip Surgery: The Past 100 Years29 June 2019Legg-Calvé-Perthes Disease: Treatments1 April 2014Arthrodiatasis for the Treatment of Perthes’ Disease9 November 2009 | OrthopedicsLegg-Calvé-Perthes DiseaseResults of Femoral Varus Osteotomy in Children Older Than 9 Years of Age With Perthes DiseaseJournal of Pediatric Orthopaedics, Vol. 21, No. 2Journal of Pediatric Orthopedics, Vol. 21, No. 2Legg–Calve–Perthes DiseaseThe Results of a Double-Blind Trial of Pulsed Electromagnetic Frequency in the Treatment of Perthes' DiseaseJournal of Pediatric Orthopaedics, Vol. 17, No. 2The Results of a Double-Blind Trial of Pulsed Electromagnetic Frequency in the Treatment of Perthes' DiseaseJournal of Pediatric Orthopaedics, Vol. 17, No. 2The treatment of Legg-Calvé-Perthes disease. A critical review of the literature.The Journal of Bone & Joint Surgery, Vol. 76, No. 3WEIGHT BEARING IN PERTHES' DISEASEOrthopedics, Vol. 14, No. 1Perthes' diseaseInternational Orthopaedics, Vol. 8, No. 2Die operative Therapie beim Morbus Perthes Vol. 64-B, No. 1 Metrics Downloaded 95 times History Published online 1 February 1982 Published in print 1 February 1982 InformationCopyright © 1982, The British Editorial Society of Bone and Joint Surgery: All rights reservedPDF download

Exercise direction for the pediatric hip surgery during the after-treatment and post-discharge period

Exercise direction for the pediatric hip surgery during the after-treatment and post-discharge period

THE TREATMENT OF ADOLESCENT SLIPPING OF THE UPPER FEMORAL EPIPHYSIS

THE TREATMENT OF ADOLESCENT SLIPPING OF THE UPPER FEMORAL EPIPHYSIS