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Multisite prospective study of perioperative pain management practices for anterior cruciate ligament reconstruction in adolescents: Society for Pediatric Anesthesia Improvement Network (SPAIN) Project Report
  1. Kesavan Sadacharam1,
  2. James S Furstein2,
  3. Steven J Staffa3,
  4. Galaxy Li4,
  5. Rami Karroum5,
  6. Jocelyn M Booth3,
  7. Eugene Kim6,
  8. Suzanne M McCahan1,
  9. Wallis T Muhly7 and
  10. Vidya Chidambaran8
  11. SPAIN-ACL Investigators
    1. 1Nemours Children's Hospital Delaware, Wilmington, Delaware, USA
    2. 2Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
    3. 3Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA
    4. 4Nemours Children's Health System, Jacksonville, Florida, USA
    5. 5Department of Anesthesiology and Pain Medicine, Akron Children's Hospital, Akron, Ohio, USA
    6. 6Department of Anesthesiology and Critical Care Medicine, Division of Pain Medicine, Los Angeles, California, USA
    7. 7Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
    8. 8Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
    1. Correspondence to Dr Kesavan Sadacharam, Nemours Children's Hospital Delaware, Wilmington, Delaware, USA; kesavan2654{at}gmail.com

    Abstract

    Introduction Although 200 000 adolescents undergo anterior cruciate ligament reconstruction (ACLR) surgery annually, no benchmarks for pediatric post-ACLR pain management exist. We created a multicenter, prospective, observational registry to describe pain practices, pain, and functional recovery after pediatric ACLR.

    Methods Participants (n=519; 12–17.5 years) were enrolled from 15 sites over 2 years. Data on perioperative management and surgical factors were collected. Pain/opioid use and Lysholm scores were assessed preoperatively, on postoperative day 1 (POD1), POD3, week 6, and month 6. Descriptive statistics and trends for opioid use, pain, and function are presented.

    Results Regional analgesia was performed in 447/519 (86%) subjects; of these, adductor canal single shot was most frequent (54%), nerve catheters placed in 24%, and perineural adjuvants used in 43%. On POD1, POD3, week 6, and month 6, survey response rates were 73%, 71%, 61%, and 45%, respectively. Over these respective time points, pain score >3/10 was reported by 64% (95% CI: 59% to 69%), 46% (95% CI: 41% to 52%), 5% (95% CI: 3% to 8%), and 3% (95% CI: 1% to 6%); the number of daily oxycodone doses used was 2.8 (SD 0.19), 1.8 (SD 0.13), 0, and 0. There was considerable variability in timing and tests for postdischarge functional assessments. Numbness and weakness were reported by 11% and 4% at week 6 (n=315) and 16% and 2% at month 6 (n=233), respectively.

    Conclusion We found substantial variability in the use of blocks to manage post-ACLR pain in children, with a small percentage experiencing long-term pain and neurological symptoms. Studies are needed to determine best practices for regional anesthesia and functional assessments in this patient population.

    • Pain, Postoperative
    • Analgesics, Opioid
    • Lower Extremity
    • Pediatrics

    Data availability statement

    Data are available upon reasonable request.

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • X @vidyachidambar1

    • Collaborators COLLABORATORS (SPAIN-ACL): Recruiting Site Principal Investigators Joseph P Cravero,(conceptualization, methodology, writing—review and editing), Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA; James Bradley, MPH, FASA (supervision, conceptualization, project administrator, writing—review and editing) Le Bonheur Children’s Hospital, Memphis, TN; Matthew Ellington (investigation, supervision, writing—review and editing), Central Texas Pediatric Orthopedics, University of Texas Austin, Austin, TX; Tessa Mandler (investigation, supervision, writing—review and editing), Department of Pediatric Anesthesiology, Children’s Hospital of Colorado, Aurora, CO; Brad Taicher, DO, MBA (investigation, supervision, writing—review and editing), Department of Anesthesiology, Duke University, Durham, NC; Marnie B Welch (investigation, supervision, writing—review and editing), Department of Anesthesiology, Dartmouth Hitchcock Medical Center, Lebanon, NH; Allison Fernandez (investigation, supervision, writing—review and editing), Department of Anesthesia and Pain Medicine, John Hopkin’s All Children’s Hospital, St Petersburg, FL; Galit Kastner Ungar (investigation, supervision, writing—review and editing), Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX; Clint Fuller (project administration, investigation, writing—review and editing). Recruiting Site Coinvestigators Stephen Kelleher (investigation, methodology, supervision, validation, writing—review and editing), Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA; Matthew Milewski, MD (methodology, writing—review and editing), Department of Orthopedic Surgery and Sports Medicine, Boston Children’s Hospital, Boston, MA; Carolyn Bannister, MD (data curation, investigation, project administration, resources, validation, writing—review and editing), Associate Professor, Emory University, Atlanta, GA; Robert Scott Lang (investigation, writing—review and editing), Department of Anesthesiology, Nemours Children’s Health, Wilmington, DE; Chris Glover, MD (project administration, investigation, writing—review and editing), Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children’s Hospital, Houston, TX; Blaine Zelisko (project administration, writing—review and editing), Department of Anesthesiology, Cook Children’s, Fort Worth, TX; Tarun Bhalla, MBA, FSA (project administration, investigation, supervision, writing—review and editing), Akron Children’s Hospital, Akron, OH; Matthew C Mitchell, DO (project administration, investigation, supervision, writing—review and editing), Akron Children’s Hospital, Akron, OH; Paul Befanti (investigation, writing—review and editing), Department of Orthopedic Surgery, John Hopkin’s All Children’s Hospital, St Petersburg, FL; Drew Warnick (investigation, writing—review and editing), Department of Orthopedic Surgery, John Hopkin’s All Children’s Hospital, St Petersburg, FL; Kymberly Householder, BSN (investigation, writing—review and editing), Department of Anesthesia and Pain Medicine, John Hopkin’s All Children’s Hospital, St Petersburg, FL; Melissa Masarrachia (conceptualization, project administration), Department of Pediatric Anesthesiology, Children’s Hospital of Colorado, Aurora, CO; Brian Ohlendorf (project administration, investigation, writing—review and editing), Department of Anesthesiology, Duke University, Durham, NC; Brian Lau, MD (project administration, investigation, writing—review and editing), Department of Anesthesiology, Duke University, Durham, NC; Lisa Einhorn (project administration, investigation, writing—review and editing), Department of Anesthesiology, Duke University, Durham, NC (currently affiliated with Boston Children’s Hospital, Boston, MA).

    • Contributors Study conception and design: KS, JPC, VC. Acquisition of data: KS, JSF, GL, RK, SMM, JMB, EK, VC. Analysis and interpretation: SJS, KS, VC, WTM. Drafting: KS, JMB, WTM, VC, JSF, GL, SJS, RK, EK, SMM. Revising: KS, VC, JMB, GL, EK, SJS, JMB, RK, WTM. All authors gave approval for publication of the manuscript, Guarantor: KS.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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