Postoperative outcomes of peripheral nerve block versus general endotracheal anesthesia for orthopedic upper limb surgery among pediatric patients: cohort study
Gaea Hansel Porquis,1 Dahlia Arancel1 2 3 4 5 6 7 8
1Department of Anesthesiology, Southern Philippines Medical Center, Bajada, Davao City, Philippines
2Davao Medical School Foundation Hospital, Medical School Drive, Bajada, Davao City, Philippines
3Ricardo Limso Medical Center, Ilustre St, Poblacion District, Davao City, Philippines
4Brokenshire Integrated Health Ministries Inc, Brokenshire Heights, Madapo, Davao City, Philippines
5Metro Davao Medical & Research Center Inc, JP Laurel Ave, Davao City, Philippines
6Department of Anesthesiology, San Pedro Hospital of Davao City Inc, C Guzman St, Davao City, Philippines
7Community Health and Development Cooperative Hospital, Anda Riverside, Davao City, Philippines
8College of Medicine, Davao Medical School Foundation Hospital, Medical School Drive, Bajada, Davao City, Philippines
Correspondence Gaea Hansel Porquis, firstname.lastname@example.org
Article editors Eugene Lee Barinaga, Ludivina Porticos
Received 25 July 2017
Accepted 24 October 2017
Cite as Porquis GH, Arancel D. Outcomes of peripheral nerve block versus general endotracheal anesthesia for upper limb orthopedic surgery among pediatric patients: cohort study. SPMC J Health Care Serv. 2017;3(2):2. http://n2t.net/ark:/76951/jhcs4cq5m4
Background. Compared to adult patients undergoing upper limb surgery who receive general endotracheal anesthesia (GETA), those who receive peripheral nerve block (PNB) have better postoperative outcomes.
Objective. To compare postoperative outcomes of PNB and GETA for orthopedic upper limb surgery among pediatric patients.
Design. Cohort study.
Setting. Southern Philippines Medical Center, Davao City, from December 2015 to May 2016.
Participants. 94 boys and girls, 3 to 18 years old, who received either PNB or GETA for orthopedic upper limb surgery.
Main outcome measures. Postoperative pain by visual analogue scale (VAS), need for postoperative rescue opioid doses.
Main results. Of the 94 patients in this study, 47 (50%) received PNB, and the rest received GETA prior to surgery. Patients in the two anesthesia groups were comparable at baseline. The PNB group had lower mean VAS scores compared to the GETA group both at the post-anesthesia care unit (0.70 ± 1.52 versus 4.15 ± 1.78; p<0.001) and at the Orthopedics Ward (0.45 ± 1.49 versus 4.13 ± 1.68; p<0.001). The proportion of patients given postoperative rescue opioid doses was significantly lower in the PNB group (6/47; 12.77%) than in the GETA group (21/47; 44.62%; p=0.0006).
Conclusion. Pediatric patients for orthopedic upper limb surgery who received PNB had less pain postoperatively and needed postoperative rescue opioid doses less frequently compared to those who received GETA.
Keywords. regional anesthesia, Modified Aldrete Score, Pasero Opioid-Induced Sedation Scale, postoperative nausea and vomiting
Table 1 Demographic and clinical characteristics of patients according to type of anesthesia
|Mean age ± SD, years||9.98 ± 3.96||9.02 ± 4.22||0.2596|
|Sex, frequency (%)||1.0000|
|Male||9 (19.15)||9 (19.15)|
|Female||38 (80.85)||38 (80.85)|
|ASA classification, frequency (%)||1.0000|
|I||41 (87.23)||41 (87.23)|
|II||6 (12.77)||6 (12.77)|
|Pneumonia, frequency (%)||2 (4.26)||1 (2.13)||1.0000*|
|Bronchial asthma, frequency (%)||2 (4.26)||5 (10.64)||0.4349*|
|URTI, frequency (%)||1 (2.13)||0 (0.00)||1.0000*|
|VSD, frequency (%)||1 (2.13)||0 (0.00)||1.0000*|
*using Fisher’s exact test.
Table 2 Postoperative outcomes of patients according to type of anesthesia
|Mean VAS score 30 minutes after entry to the PACU ± SD||0.70 ± 1.52||4.15 ± 1.78||<0.0001*|
|Mean VAS score at the Orthopedics Ward 24 hours after surgery ± SL||0.45 ± 1.49||4.13 ± 1.68||<0.0001*|
|Mean POISS score upon entry to the PACU ± SD||0.04 ± 0.29||0.48 ± 0.86||0.0015*|
|Mean POISS score upon entry to the Orthopedics Ward ± SD||0.09 ± 0.41||0.38 ± 0.80||0.0015*|
|Mean PONV Impact Scale score at the PACU ± SD||0||0.06 ± 0.32||0.1792|
|Mean PONV Impact Scale score at the Orthopedics Ward ± SD||0||0||1.0000|
|Patients given postoperative opioid rescue dose, frequency (%)||6 (12.77)||21 (44.62)||0.0006*|
|Mean age ± SD, years†||11.33 ± 3.08||9.10 ± 3.95||0.2138|
|Mean cumulative postoperative rescue opioid dose ± SD, mg||6.17 ± 3.87||3.98 ± 1.65||0.0477*|
|Mean Modified Aldrete Score after 30 minutes at the PACU ± SD||8.45 ± 1.54||7.66 ± 0.82||0.0026*|
|Eligible for discharge from the PACU after 30 minutes, frequency (%)||44 (93.62)||27 (57.45%)||<0.0001|
|Mean duration of PACU stay ± SD, minutes||119.64 ± 43.70||134.60 ± 54.51||0.1456|
We extend our sincerest gratitude to Ms Marilou Rodrigo Igos, Dr Elsa N Calvez and Dr Mandeep Pathak for the census they provided for our research. We also thank the nurses at the Post-Anesthesia Care Unit and the Orthopedics Ward of Southern Philippines Medical Center for their assistance during the conduct of our study.
This study was reviewed and approved by the Department of Health XI Cluster Ethics Review Committee (DOH XI CERC reference P15050501).
Reporting guideline used
Supported by personal funds of the authors
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