Key result
Peripheral regional blocks, such as lumbar plexus and fascia iliaca blocks, provide analgesic efficacy comparable to epidural and caudal anesthesia for pediatric hip surgery, though no single technique has proven superior.
Why the study?
Intra- and postoperative analgesia for pediatric hip surgery remains limited to epidural anesthesia despite known disadvantages, while peripheral regional blocks are widespread in adults.
Do peripheral regional blocks provide effective and safe analgesia compared to neuroaxial anesthesia in children undergoing hip surgery?
Do peripheral regional blocks provide effective and safe analgesia compared to neuroaxial anesthesia in children undergoing hip surgery?
Peripheral regional blocks, such as lumbar plexus and fascia iliaca blocks, offer effective analgesia comparable to neuroaxial techniques for pediatric hip surgery, though further studies are needed to establish the optimal approach.
Ultrasound-guided peripheral blocks may offer epidural alternatives in pediatric hip surgery; hypothesis-generating, needs prospective trials before adoption.
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.
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Novikova et al. (2023) conducted a review in Hip joint diseases requiring surgery. Peripheral regional anesthesia (e.g., lumbar plexus block, fascia iliaca block, PENG block) vs. Neuraxial anesthesia (epidural, caudal) or other peripheral blocks was evaluated on Analgesic efficacy and safety. Peripheral regional blocks, such as lumbar plexus and fascia iliaca blocks, provide analgesic efficacy comparable to epidural and caudal anesthesia for pediatric hip surgery, though no single technique has proven superior.
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