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Abstract
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Background and Aims Orthopedic surgery is common in paediatric patients with cerebral palsy, aiming in increasing mobility and reducing muscle spasms. Postoperative pain control is often challenging due to coexisting conditions
Methods A 13 year old male patient was scheduled for femoral tendon lengthening. The child had been born as a premature neonate at 34 weeks of gestation, and had undergone Achilles tendon lengthening also in the past. After induction of general anaesthesia, an initial plan for popliteal block was abandoned due to U/S resources unavailability at particular moment. Intraoperatively and while patient was at the prone position, the sciatic nerve was visible at the popliteal level, thus we decided for sciatic blockade under direct view. 10 ml of Ropivacaine 0.2% were injected perineurally. Fentanyl (5 micrograms/kg), Paracetamol, Dexamethasone, Diclofenac sodium and Morphine were given additionally. The patient woke up referring no pain in post anaesthetic unit, while in the ward only the standard dose of paracetamol was administered
Results After tendon lengthening postoperative muscle spasms may cause severe pain, and adequate pain control is often complex due to coexisting conditions. Popliteal nerve block has been shown to reduce the analgesic use in postoperative period. In this patient popliteal block was not possible. So, a perineural infiltration at the popliteal level under direct view was an analgesic supplement
Sciatic nerve division to tibial and common peroneal nerves
Injection of local anaesthetic
Conclusions Sciatic nerve block at the popliteal level under direct view proved to be an effective analgesic supplement where popliteal block was not feasible in a 13 year old patient with cerebral palsy that underwent femoral tendon lengthening