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Use of regional anesthesia within a pediatric interventional radiology suite reduced periprocedural opioid use without delaying the overall workflow: a retrospective study
  1. Jordan I Gaelen1,
  2. Chunyi Wu1,
  3. Amy Yang1,
  4. Shankar Rajeswaran2,
  5. Alina Lazar1,
  6. Eric C Cheon1 and
  7. Angelica A Vargas1
  1. 1Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
  2. 2Division of Interventional Radiology, Department of Radiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
  1. Correspondence to Dr Angelica A Vargas, Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA; avargas{at}luriechildrens.org

Abstract

Background Nerve block utility has been extensively described in the operating room, however, there is a paucity of evidence regarding blocks in the interventional radiology (IR) suite, with no studies examining its safety and efficacy in children.

Methods A retrospective study was conducted at a single tertiary-care children’s hospital to evaluate the analgesic utility of nerve blocks during IR-performed sclerotherapy for bone cysts, venous malformations, and lymphatic malformations. Lymphatic and venous malformations were combined for final analysis. Patients between January 2016 and September 2022 had their medical records reviewed for procedural data, postprocedural pain scores, and analgesic administration data.

Results 309 patients were included in the final analysis. Opioids were required significantly less frequently intraprocedurally and postprocedurally across subgroups. The proportion of patients who received opioids during their hospital course was significant between block and non-block patients, respectively: bone cyst: 62.7% vs 100% (p<0.001); venous and lymphatic malformation: 65.7% vs 97.4% (p<0.001). Average maximum postanesthesia care unit (PACU) pain scores were significantly lower in bone cyst patients with no significant difference seen in pain scores among venous and lymphatic malformation patients. There were no reported nerve block-related complications.

Discussion Nerve blocks demonstrated an opioid-sparing effect intraprocedurally and postprocedurally for all subgroups. Their use among bone cyst patients was associated with significant reductions in average maximum PACU pain scores. Nerve blocks may constitute an effective opioid-sparing component of multimodal analgesia in pediatric patients undergoing IR sclerosis procedures. Prospective data are needed to establish the optimal utility of nerve blocks in the IR setting.

  • REGIONAL ANESTHESIA
  • Pain Management
  • Nerve Block
  • Pediatrics
  • Pain, Postoperative

Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information.

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Footnotes

  • X @shankswaranir

  • Contributors JIG: formal analysis, investigation, data curation, writing—original draft, visualization, writing—review and editing; CW: formal analysis, data curation, visualization, writing—review and editing; AY: methodology, formal analysis, investigation, data curation, writing—original draft; SR: conceptualization, methodology, investigation, writing—original draft, writing—review and editing, validation; AL: writing—original draft, visualization, writing—review and editing; ECC: writing—original draft, writing—review and editing, validation; AAV: conceptualization, methodology, validation, investigation, writing—original draft, guarantor, writing—review and editing.

  • 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.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.