title: Review of outcomes in pediatric patients undergoing anterior cruciate ligament repairs with regional nerve blocks.
abstract: OBJECTIVE
  This article compared the outcomes of pediatric patients undergoing ACL repairs receiving intravenous opioids versus regional nerve blocks for pain management. It was hypothesized that compared to intravenous opioids the use of regional nerve blocks would decrease pain, opioid consumption, and opioid-related side effects.
  
  
  METHODS
  A random retrospective chart review was conducted on a total of 93 pediatric patients who underwent ACL repairs either in 2004 prior to the implementation of regional nerve blocks for pain management [pre-protocol cohort, (n=44)] or in 2009/2010, after the implementation of regional nerve block use [post-protocol cohort, (n=49)].
  
  
  RESULTS
  The two cohorts were comparable in age, weight and gender. The post-protocol cohort had a significantly lower total opioid consumption (p<0.001). A sensitivity analysis excluding patients who received patient controlled analgesia (PCA) further validated the findings of significantly lower total opioid consumption adjusted for body weight [mg/kg] (p=0.02) and reduction in the highest numerical rating score (NRS) reported on post-operative day (POD) 1 (p=0.01). The cohorts were not significantly different in incidence of common opioid-related side effects or median length of stay (LOS).
  
  
  CONCLUSIONS
  There was evidence that regional nerve blocks reduced opioid consumption and also impacted pain reduction on POD 1 but demonstrated no significant change on opioid-related side effects or readiness for discharge. In view of the retrospective nature of the study the potential benefits of regional nerve blocks suggested a clinical equipoise to conduct a controlled trial in children.
authors.affiliation: Department of Surgery, Boston Children's Hospital, Boston, MA. Electronic address: rosella.micalizzi@childrens.harvard.edu.
authors.forename: Rosella A
authors.initials: RA
authors.lastname: Micalizzi
authors.affiliation: Department of Surgery, Boston Children's Hospital, Boston, MA.
authors.forename: Lee Ann
authors.initials: LA
authors.lastname: Williams
authors.affiliation: Department of Surgery, Boston Children's Hospital, Boston, MA.
authors.forename: Shelly
authors.initials: S
authors.lastname: Pignataro
authors.affiliation: Department of Anesthesiology, Perioperative & Pain Medicine, Boston Children's Hospital, Boston, MA.
authors.forename: Navil F
authors.initials: NF
authors.lastname: Sethna
authors.affiliation: Department of Anesthesiology, Perioperative & Pain Medicine, Boston Children's Hospital, Boston, MA.
authors.forename: David
authors.initials: D
authors.lastname: Zurakowski
mesh_terms: D000293:Adolescent; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D059549:Anterior Cruciate Ligament Reconstruction; D002648:Child; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D009407:Nerve Block; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid
keywords: Anterior cruciate ligament injury; Anterior cruciate ligament repair; Femoral nerve blocks; Opioid medication; Pain management; Pediatrics; Regional nerve blocks