title: A case series of peripheral nerve blocks in pediatrics and young adults with skeletal dysplasia.
abstract: OBJECTIVE
  The purpose of this study was to report our experience with peripheral nerve blockade in pediatric and young adult patients with skeletal dysplasia undergoing knee arthroscopy.
  
  
  BACKGROUND
  The incidence of skeletal dysplasia is 1:4000 live births. These patients have biomechanical predispositions to knee joint degeneration, which is often palliated by arthroscopic surgery. Regional anesthesia has been proven to improve the cost and quality of care in adults undergoing arthroscopic knee surgery.
  
  
  METHODS
  This was a retrospective case series of patients with skeletal dysplasia undergoing arthroscopic knee surgery from 2012-2014 at a tertiary-care, pediatric hospital. Data pertaining to block effectiveness, technique, adjunct local anesthetic, rates of postoperative nausea/vomiting and admissions, and complications were recorded.
  
  
  RESULTS
  Twenty patients with skeletal dysplasia underwent arthroscopic knee surgery during the study period. Ten of these patients received peripheral nerve blockade (12 procedures). All patients received femoral, femoral/sciatic, or femoral/sciatic/obturator blocks. One patient required opioid, constituting a block failure. The same patient required overnight admission for pain control. No patients suffered from PONV. There were no complications associated with any of the blocks performed.
  
  
  CONCLUSIONS
  Patients with skeletal dysplasia receiving lower extremity nerve blocks consume minimal opioid and report no major complications. Anesthesiologists should consider this mode of anesthesia in these patients. While no nerve injuries were discovered, further study is necessary to determine whether rates of nerve injury are comparable to that in the general pediatric population. Given the size of the skeletal dysplasia population, this type of study would require close to a decade of metadata from numerous institutions.
authors.affiliation: Department of Anesthesiology, University of Oklahoma School of Medicine, Oklahoma City, OK, USA.
authors.forename: James R
authors.initials: JR
authors.lastname: Eiszner
authors.affiliation: Department of Orthopedic Surgery, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA.
authors.forename: Alfred
authors.initials: A
authors.lastname: Atanda
authors.affiliation: Department of Anesthesiology, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Ashwin
authors.initials: A
authors.lastname: Rangavajjula
authors.affiliation: Department of Anesthesiology and Critical Care, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA.
authors.forename: Mary
authors.initials: M
authors.lastname: Theroux
mesh_terms: D000293:Adolescent; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D000779:Anesthetics, Local; D001182:Arthroscopy / Q000379:methods; D001848:Bone Diseases, Developmental / Q000601:surgery*; D002648:Child; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007717:Knee / Q000601:surgery; D008297:Male; D009407:Nerve Block; D011183:Postoperative Complications / Q000453:epidemiology; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local
keywords: developmental bone diseases; local anesthesia; musculoskeletal abnormalities; nerve block; pain management; regional anesthesia