ERECTOR SPINAE PLANE BLOCK AND PLACEMENT OF PERINEURAL CATHETER FOR DEVELOPMENTAL HIP DISORDER SURGERY IN CHILDREN.

The ultrasound-guided erector spinae plane (ESP) block is a novel interfascial plane block technique providing analgesic effects in different localizations of the body, in accordance with the level of administration. Although ESP block is usually performed in the thoracic region in pediatric patients, it is possible to achieve ESP block in the lumbar region as well. Postoperative pain management is essential in patients undergoing operative hip treatment, one of the most common procedures in pediatric orthopedic surgery. We report on a case of effective intraoperative analgesia achieved by ultrasound-guided lumbar ESP block and another case of effective intra- and postoperative analgesia accomplished with perineural catheter placement in addition to lumbar ESP block, both performed in children surgically treated for developmental hip disorders.

The Safety and Efficacy of the Continuous Peripheral Nerve Block in Postoperative Analgesia of Pediatric Patients.

Postoperative analgesia is imperative in the youngest patients. Pain, especially if experienced during childhood, has numerous adverse effects-from psychological, through complications of the underlying disease (prolonged treatment, hospital stay, and increased costs of the treatment) to an increase in the incidence of death due to the onset of the systemic inflammatory response. Peripheral blocks provide analgesia for 12-16 h, and are safer due to rare side effects that are easier to treat. The continuous peripheral block (CPNB) has been increasingly used in recent years for complete and prolonged analgesia of pediatric patients, as well as a part of multidisciplinary treatment of complex regional pain syndrome. It has been shown that outpatient CPNB reduces the need for parenteral administration of opioid analgetics. It has also been proved that this technique can be used in pediatric patients in home conditions. Safety of CPNB is based on the increasing use of ultrasound as well as on the introduction of single enantiomers local anesthetics (ropivacaine and levobupivacaine) in lower concentrations. It is possible to discharge patient home with catheter, but it is necessary to provide adequate education for staff, patients, and parents, as well as to have dedicated anesthesiology team. Postoperative period without major pain raises the morale of the child, parents. and medical staff.