Is the psoas compartment block effective in eliminating pain in children after hip surgery?

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Abstract

BACKGROUND: Hip joint surgery is a highly traumatic surgical intervention. Currently, the anesthesia service in the clinic of H. Turner National Medical Research Center uses either prolonged epidural block with catheter placement in the lumbar spine at the LIII–LIV level or prolonged intravenous analgesia as the main method of pain syndrome treatment after hip joint surgery. Moreover, the potential of prolonged psoas compartment block has not been considered until recently.

AIM: To evaluate the effectiveness of prolonged psoas compartment block for pain control in the early postoperative period after hip surgery in comparison with traditional methods of pain control.

MATERIALS AND METHODS: This study analyzed the results of postoperative analgesia in 14 children after 15 surgeries in the hip joint, including 3 patients with prolonged psoas compartment block, 9 with prolonged epidural block, and 3 who received postoperative analgesia with systemic analgesics. One patient with bilateral congenital hip joint dislocation was anesthetized with prolonged psoas compartment block after the first operation for the first time and with prolonged epidural block after the second similar operation but on the other leg for the second time. Analgesia efficacy was assessed using the Wong–Baker scale, FLACC behavioral scale, and visual analog scale.

RESULTS: All three patients with prolonged psoas compartment block required an addition of butorphanol tartrate (tramal) for good analgesia. Additional administration of opioid analgesics was not needed when a prolonged epidural block was initiated.

CONCLUSIONS: Due to the continued need for additional administration of butorphanol tartrate, when prolonged epidural block was available, the use of prolonged psoas compartment block in children for pain relief in the early postoperative period after hip surgery was not considered appropriate.

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About the authors

Sergei V. Vissarionov

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: vissarionovs@gmail.com
ORCID iD: 0000-0003-4235-5048
SPIN-code: 7125-4930

MD, PhD, Dr. Sci. (Med.), Professor, Corresponding Member of RAS

Russian Federation, Saint Petersburg

Viktor A. Koriachkin

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery; Saint Petersburg State Pediatric Medical University

Email: vakoryachkin@mail.ru
ORCID iD: 0000-0002-3400-8989
SPIN-code: 6101-0578

MD, PhD, Dr. Sci. (Med.), Professor

Russian Federation, Saint Petersburg; Saint Petersburg

Dmitry V. Zabolotskii

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery; Saint Petersburg State Pediatric Medical University

Email: zdv4330303@gmail.com
ORCID iD: 0000-0002-6127-0798
SPIN-code: 6726-2571
Russian Federation, Saint Petersburg; Saint Petersburg

Rustam R. Safin

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery; Federal State Kazan (Volga) University

Author for correspondence.
Email: safin_r.r@hotmail.com
ORCID iD: 0000-0003-0960-7426
SPIN-code: 7464-7151

MD, PhD, Dr. Sci. (Med.)

Russian Federation, Saint Petersburg; Kazan

Pavel I. Bortulev

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: pavel.bortulev@yandex.ru
ORCID iD: 0000-0003-4931-2817
SPIN-code: 9903-6861

MD, PhD, Cand. Sci. (Med.)

Russian Federation, Saint Petersburg

Tamila V. Baskaeva

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: tamila-baskaeva@mail.ru
ORCID iD: 0000-0001-9865-2434
SPIN-code: 5487-4230

MD, orthopedic and trauma surgeon

Russian Federation, Saint Petersburg

Mikhail N. Dolgopolskii

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: mdolgopolsky@gmail.com
ORCID iD: 0000-0001-7690-2340

MD, anesthesiologist and intensivist

Russian Federation, Saint Petersburg

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Supplementary files

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2. Fig. 1. Clinical case 2 (patient 2): contrasting the fascial case of the psoas major muscle

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3. Fig. 2. Patient 3: a, withdrawal of the needle slice from the lumbar plexus; b, catheterization of the lumbar compartment. Ultrasonographic landmarks in the axial scanning plane at the level of the LIV–V vertebrae (linear transducer, 14 MHz): Corp. L4, body of the IV lumbar vertebra; M. ES, back erector muscle; M. PM, large lumbar muscle; M. QL, quadratus lumborum muscle; Pl. Lumb (L1–4), lumbar plexus at the LIV–V level of the ultrasonographic slice; Pr. Tr L4, transverse process of the IV lumbar vertebra

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4. Fig. 3. Patient 3: a, with bilateral hip dislocation (clinical case 3); b, after the first stage of surgical treatment (clinical case 3); c, after the second stage of surgical treatment (clinical case 4)

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