Background and Aims Prolonged epidural analgesia (PEA) is effective in surgeries done for spastic hip dislocation in children with cerebral palsy and severe forms of motor dysfunction: IV-V levels according to Gross Motor Function Classification System (GMFSC). Sometimes PEA becomes impossible due to anatomic peculiarities and contraindications. The purpose of this study is to compare different methods of regional analgesia and sedation in children with cerebral palsy for hip surgeries combined with muscle-tendon plasty.
Methods One hundred and one children were included into prospective randomized study, which was approved by local Ethics Committee. Patients received general anesthesia supplemented: PEA and analgo-sedation with fentanyl (group EAA, 32 patients); PEA and sedation with benzodiazepines (group EABS, 37 patients); prolonged femoral nerve block with single ischial nerve blockade (group PCABS, 32 patients). Intensity of pain according to r-FLACC scale, degree of agitation and sedation according to RASS scale, depth of sedation according to Ramsay were evaluated after waking-up, in 6 hours after surgery and on 1 POD. We calculated prescription of NSAIDs and opioids. ANOVA, χ2 were used.
Results Paracetamol was prescribed to 15 patients (47%) in group EAA, 32 (86.5%) in group EABS, 31 (97%) in group PCABS (p<0.001). Patients EABS and PCABS did not need opioids. There were no differences between groups according to scales r-FLACC, RASS and Ramsay (p>0.05).
Conclusions PEA, prolonged femoral nerve analgesia together with single ischial nerve blockade in combination with NSAIDs are equally effective in hip surgeries in children with cerebral palsy. Sedation with benzodiazepines decreases the need for narcotic analgesics.