Pediatric orthopaedic surgeon R. Jay Lee discusses his latest research: “Decrease in Residual Neurological Symptoms After Institutional Changes in Peripheral Nerve Block Use for Pediatric Knee Surgery”.
Read the paper: pubmed.ncbi.nlm.nih.gov/34995258
adequate pain management and minimizing the use of opiate pain medications after knee surgery is a common concern for parents and their Children. Peripheral nerve blocks are a common way to minimize the inter operative and postoperative use of narcotics. Historically, peripheral nerve blocks have been thought to have an extremely low one in 10,000 complication rate in the anesthesia literature. However, from a surgeon's perspective and our clinical experience, the complication rates appear to be much higher. Thus our goals for the studies were twofold. We aim to get a more accurate count of the complication rate to better inform surgeons and their patients in the decision making process and once this issue was identified and changes were made, we aim to reflect on how we can make this great intervention a safe and selective offering for patients. So initially we looked at a series of patients that had peripheral nerve blocks for pediatric knee surgeries. Importantly, we noted in this first study that the complication rate was indeed higher somewhere in the one in 100 range rather than the one in 10,000, we looked at factors which played a role in our academic institution. After digesting the data, we adopted a more selective approach and the complication rates dropped significantly in our second study. Ultimately, our studies demonstrate that though peripheral nerve blocks are an excellent adjunct for pain control, a thoughtful discussion with the patient is warranted, careful selection of appropriate procedure for offering the nerve block by the surgeon is needed, and finally, a specialized anesthesia team is the safest way to utilize this powerful tool
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