SLR - June 2023 - Alek Frascone, DPM
Title: Does ultrasound-guided popliteal-sciatic nerve block have superior pain control in pediatric foot and ankle surgery? A randomized control trialReference: Wejjakul W, Tangwiwat S, Pangthipampai P, Halilamien P, Eamsobhana P. Does ultrasound-guided popliteal-sciatic nerve block have superior pain control in pediatric foot and ankle surgery? A randomized control trial. J Orthop Sci. 2022 Jul;27(4):844-849. doi: 10.1016/j.jos.2021.04.007. Epub 2021 May 26. PMID: 34052081.
Level of Evidence: Level 1
Scientific Literature Review
Reviewed By: Alek Frascone, DPM
Residency Program: Ascension St John Hospital. Detroit, Michigan
Podiatric Relevance :Pediatric patients can be some of the most difficult patients to treat regardless of your surgical specialty. This difficulty can stem from many reasons with pain control being one of many. With local anesthetic infiltration and peripheral nerve blocks being used for the majority of our foot and ankle surgery; there is not much research on whether one is more beneficial than the other. Tendon and osseous work during surgery in the pediatric foot and ankle could cause severe postoperative pain, which may lead to psychologic distress and chronic pain. With the opioid epidemic still relevant it is important to look at pain control as not just a housekeeping item but rather as a staple in our operative and postoperative treatment and management of our patients.
Methods: 40 pediatric patients undergoing foot and ankle tendon surgery were enrolled in the study. The study was separated into 2 groups, group 1 being from ages 1-6 and group 2 being in ages 7 through 15. Each of the 2 groups were then also divided again into group A and group B. Group A would receive a popliteal and sciatic nerve block and group B would receive local anesthetic surgical site injections before wound closure. Both forms of anesthetic will use half percent Marcaine ( 0.25ml/kg). Pain scores were recorded using CHEOPS in 1-6 years (Group 1A, 1B), NRS in age 7-15 years (Group 2A, 2B). The post-operative morphine consumption and complications were recorded.
Results: The results of the study are as follows, for 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.
Conclusions: This study outlines the importance of ensuring proper pain control during the surgical process.The authors concluded that PNB 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. With pain control being a topic that all surgeons have to deal with, the study can help the surgeon along with the parents of our pediatric patient population sleep better at night knowing we are making the correct choices for our patients .