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Topic:

Cerebral Palsy

Issue:

Hip

Category:

Neuromuscular

Title:

Efficacy of a Multimodal Surgical Site Injection for Postoperative Pain Control in Pediatric Patients With Cerebral Palsy Undergoing Hip Reconstruction: A Randomized Controlled Trial

Author:

Greig, Danielle MD; Sun, Christina A. MPH; McBride, Daniel BS; Young, Bailey DO; Klomhaus, Alexandra PhD; Swaroop, Vineeta T. MD; Thompson, Rachel M. MD

Journal:

Journal of Pediatric Orthopaedics

Date:

November/December 2024

Reference:

44(10): p e921-e928, DOI: 10.1097/BPO.0000000000002779

Level Of Evidence:

I

# of Patients:

34

Study Type:

Randomized controlled trial (RCT)

Location:

Multicenter

Summary:

The study evaluates the efficacy of a multimodal surgical site injection for pain control in pediatric patients with cerebral palsy undergoing hip reconstruction surgery. The injection includes ropivacaine, epinephrine, and ketorolac and is compared to a saline placebo. The results show significant improvements in pain control and reduced narcotic consumption in the experimental group.

Methods:

Multicenter, double-blind, placebo-controlled trial with randomization. Patients diagnosed with cerebral palsy scheduled for varus derotation osteotomy (VDRO) of the proximal femur received either the multimodal injection or normal saline. Pain scores and narcotic consumption were measured postoperatively.

Exclusions:

None specified, but all patients were under 18 years old and had cerebral palsy.

Results:

The experimental group (multimodal injection) required significantly lower narcotics (0.41 ± 0.42 vs. 1.87 ± 2.05 morphine mEQ/kg, P=0.01) and had lower pain scores (1.0 ± 0.6 vs. 2.4 ± 1.1, P<0.001) compared to controls. There were no significant differences in other variables like operative time, blood transfusion requirements, or hospital stay length.

Conclusions:

Multimodal surgical-site injections significantly improve pain control and reduce narcotic use postoperatively in pediatric cerebral palsy patients undergoing hip reconstruction, without any adverse effects.

Relevance:

Limitations:

Perspective:

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