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Major Surgery With Minor Pain: A Non-Opioid Treatment Option for Kids
What is a Femoral Nerve Block?
An ACL reconstructive procedure typically requires doctors to rely on powerful drugs, like opioids, to manage a patient’s pain. Opioids can be very effective, but they usually require a patient to stay in the hospital from one to three days. Plus, they can carry certain risks, especially in children. Usually given in pill form, opioids affect the entire body. Side effects of opioid use include drowsiness, nausea, and vomiting. Opioid use can also affect a patient’s heart rate, as well as raise concerns about dependence and addiction. Instead of relying on opioids to control pain, my colleagues and I are increasingly using a technique known as a femoral nerve block.
Using an ultrasound machine, we are able to find and numb only certain nerves in the upper leg, near the femur bone. We direct all pain medication to this one site and, when we do, all feeling to anterior aspect of the thigh and knee is cut off. In some cases, this regional anesthesia can last up to 18-24 hours, which significantly reduces a patient’s pain in the initial aftermath of surgery.
There’s No Place Like Home
Perhaps one of the most important benefits of this approach is that patients like Madison get to go home in just a matter of hours. Since we’re not using opioids to control their pain, there is no need for them to stay in the hospital. We tracked 357 children who underwent knee surgery at our hospital, as part of a recent study investigating the effects of this technique. We found that by using this method, we were able to reduce the rate of hospitalization by 98 percent.
We know patients are more comfortable at home and parents are invariably relieved to learn their child will not have to stay in the hospital.
Of course, some soreness is inevitable. Fortunately, we are able to control the patient’s pain even after they go home. The tube we insert into the femoral nerve stays in place when the patient leaves, and is attached to a pouch containing a two to three day supply of the nerve-numbing medicine. Once the medication is gone, an adult removes the tube and throws it away. It’s a simple and painless process.
Sharing Our Success
For our study’s purpose, regional anesthesia only focused on arthroscopic knee surgery. However, doctors in orthopedics are beginning to use this method for shoulder, elbow and wrist procedures. There is also benefit for abdominal procedures.
At Nationwide Children’s Hospital, we continue to perform regional anesthesia procedures, increasing the number of blocks significantly to as many as 200 per month. Spreading the knowledge to other pediatric care professionals is now a focus.
No one likes the idea of their child undergoing surgery, but by sharing success stories like Madison’s, maybe others will learn that the process doesn't always have to be quite so painful.
Tarun Bhalla, MD, is a pediatric anesthesiologist from Nationwide Children’s Hospital in Columbus where he also serves as the director of Acute Pain and Regional Anesthesia services. He is board certified in pain medicine and has a passion for both research and teaching. Bhalla is an associate professor of Anesthesiology at The Ohio State University College of Medicine.
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