Background and Aims Posterior spine instrumentation and fusion (PSF) is a painful surgery undertaken to treat adolescent idiopathic scoliosis (AIS). Ultrasound-guided Erector Spinae Plane Block (ESPB) may present a new opportunity to apply regional analgesia to pediatric patients undergoing this surgery. To date, there exist limited applications of regional anesthesia for PSF in a comprehensive enhanced recovery pathway. We assessed the feasibility of performing ESPB in patients with AIS undergoing PSF. Methods This randomized control trial was approved by the institutional review board of the Hospital for Special Surgery (IRB# 2019-2131). A total of 24 patients were enrolled; 12 patients were randomized to receive the bilateral ESPB with local anesthesia and 12 did not receive the bilateral ESPB. Patients in both the ESPB group and no block group received the same standard anesthetic/analgesic regimen. Results To reach our enrollment target of 24 participants, we approached 57 eligible patients. Out of the 12 patients randomized to the ESPB group, 9 (75.0%) successfully received the allocated intervention. Completion of the block in two patients was unsuccessful. In addition, one case was cancelled due to an unrelated intraoperative complication. Patients and their parents in the ESPB group were on average more satisfied with their pain management postoperatively than the control group. Conclusions Within our cohort, we successfully administered ESPB to 75% of the patients in the treatment group. Further studies are needed to investigate the potential benefits of ESPB improving postoperative analgesia and decreasing patient opioid requirements in patients with AIS undergoing PSF.

Abstract Background and Aims The onset of the coronavirus 2019 (COVID‐19) pandemic brought together the American Society of Regional Anesthesia and Pain Medicine (ASRA) and the European Society of Regional Anaesthesia and Pain Therapy (ESRA) to release a joint statement on anesthesia use. Their statement included a recommendation to use regional anesthesia whenever possible to mitigate the risk associated with aerosolizing procedures. We sought to examine the utilization of anesthesia in pediatric patients undergoing a surgical procedure for fractures or ligament repairs before and during COVID‐19. Methods Using the Premier Health Database, we retrospectively analyzed pediatric patients undergoing a surgical intervention for fractures or ligament repair before and during COVID‐19. We sought to determine if there were differences in anesthesia use among this cohort during the two time periods. Fracture groups included shoulder and clavicle, humerus and elbow, forearm and wrist, hand and finger, pelvis and hip, femur and knee, leg and ankles, and foot and toes. Ligament procedures included surgical intervention for the anterior cruciate ligament and ulnar collateral ligament repair. Results We identified a total of 5935 patients undergoing a surgical procedure for fractures or ligament repairs before and during COVID‐19. After exclusion for unknown anesthesia use, 2,807 patients were included in our cohort with 81.5% (n = 2288) of patients undergoing a procedure under general anesthesia, 6.4% (n = 181) under regional anesthesia, and 12.0% (n = 338) under combined general‐regional anesthesia. There did not appear to be a significant difference in the type of anesthesia used before and during COVID‐19 (p = 0.052). Conclusions Our study did not identify a difference in anesthesia use before and during COVID‐19 among pediatric patients undergoing a surgical procedure. Further studies should estimate the change in anesthesia used during the time period when elective procedures were resumed.

Background and Aims The onset of the coronavirus 2019 (COVID-19) pandemic brought together the American Society of Regional Anesthesia and Pain Medicine (ASRA) and the European Society of Regional Anaesthesia and Pain Therapy (ESRA) to release a joint statement on anesthesia use (1). Their statement included a recommendation to use regional anesthesia whenever possible to mitigate the risk associated with aerosolizing procedures. We sought to examine the utilization of anesthesia in pediatric patients undergoing a surgical procedure for fracture or ligament repair before and during COVID-19. Methods This study is approved by Hospital for Special Surgery Institutional Review Board (IRB# 2016–436). We used the Premier Healthcare Database to identify pediatric patients undergoing a surgical intervention for fractures or ligament repair before COVID-19 (March-June 2019) and during (March-June 2020). We compared general, regional, and combined general-regional use before and during COVID-19. Results We identified 6,415 patients undergoing a surgical procedure for fracture or ligament repair before and during COVID-19. After exclusions for unknown anesthesia use, 3,052 patients were included in our cohort with 82.9% (n=2,530) of patients undergoing a procedure under general anesthesia, 6.0% (n=182) under regional anesthesia, and 11.1% (n=340) under combined general-regional anesthesia. There was no difference in the type of anesthesia used before and during COVID-19 (p=0.053, Table 1). Conclusions We did not find a significant difference in anesthesia use before and during COVID-19 among pediatric patients undergoing a surgical procedure. The significance of these findings highlights how societal recommendations and historical precedent may not influence pediatric anesthesia practice models.

BACKGROUND:Cleft repair requires multiple operations from infancy through adolescence, with repeated exposure to opioids and their associated risks. The authors implemented a quality improvement project to reduce perioperative opioid exposure in their cleft lip/palate population.METHODS:After identifying key drivers of perioperative opioid administration, quality improvement interventions were developed to address these key drivers and reduce postoperative opioid administration from 0.30 mg/kg of morphine equivalents to 0.20 mg/kg of morphine equivalents. Data were retrospectively collected from January 1, 2015, until initiation of the quality improvement project (May 1, 2017), tracked over the 6-month quality improvement study period, and the subsequent 14 months. Metrics included morphine equivalents of opioids received during admission, administration of intraoperative nerve blocks, adherence to revised electronic medical record order sets, length of stay, and pain scores.RESULTS:The final sample included 624 patients. Before implementation (n =354), children received an average of 0.30 mg/kg of morphine equivalents postoperatively. After implementation (n = 270), children received an average of 0.14 mg/kg of morphine equivalents postoperatively (p < 0.001) without increased length of stay (28.3 versus 28.7 hours; p = 0.719) or pain at less than 6 hours (1.78 versus 1.74; p = 0.626) or more than 6 hours postoperatively (1.50 versus 1.49; p = 0.924).CONCLUSIONS:Perioperative opioid administration after cleft repair can be reduced in a relatively short period by identifying key drivers and addressing perioperative education, standardization of intraoperative pain control, and postoperative prioritization of nonopioid medications and nonpharmacologic pain control. The authors' quality improvement framework has promise for adaptation in future efforts to reduce opioid use in other surgical patient populations.CLINICAL QUESTION/LEVEL OF EVIDENCE:Therapeutic, III.

Harvesting of iliac crest bone graft for alveolar cleft repair in children is associated with significant postoperative pain. Transversalis fascia plane block has emerged as an alternative to local wound infiltration for iliac crest bone graft harvesting and has been used with good effect in adult patients requiring bone graft for orthopedic surgery. Little is known about the use of the transversalis fascia plane block in children or the feasibility of placing a continuous infusion catheter. In this report, we describe our experience using a continuous transversalis fascia plane infusion catheter in the management of a 6-year-old girl undergoing alveolar cleft repair with iliac crest bone graft.

Pain ManagementVol. 6, No. 3 CommentaryNeuromodulation: a focus on dorsal root ganglion stimulationNicholas Bremer, Jordan Ruby, Paul D Weyker & Christopher AJ WebbNicholas Bremer Department of Anesthesiology, Columbia University College of Physicians & Surgeons, New York, NY, USA, Jordan Ruby Department of Anesthesiology, Perioperative & Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA, Paul D Weyker Department of Anesthesiology, Division of Pain Medicine, Columbia University Medical Center, New York, NY, USA Department of Anesthesiology, Division of Critical Care, Columbia University Medical Center, New York, NY, USA & Christopher AJ Webb*Author for correspondence: E-mail Address: cw2538@cumc.columbia.edu Department of Anesthesiology, Division of Pain Medicine, Columbia University Medical Center, New York, NY, USA Department of Anesthesiology, Division of Regional Anesthesia, Columbia University Medical Center, New York, NY, USAPublished Online:15 Mar 2016https://doi.org/10.2217/pmt-2015-0013AboutSectionsView ArticleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinkedInReddit View articleKeywords: chronic paindorsal root ganglion stimulationneuromodulationneuropathic painsensitizationspinal cord stimulationReferences1 Kane K, Taub A. 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Neuromodulation 18(7), 610–617 (2015).Crossref, Medline, Google ScholarFiguresReferencesRelatedDetailsCited ByAnatomical analysis of sensory ganglia in miceStress and Brain, Vol. 2, No. 4Supraspinal Effects of Dorsal Root Ganglion Stimulation in Chronic Pain PatientsNeuromodulation: Technology at the Neural Interface, Vol. 24, No. 4Excitatory and inhibitory effects of stimulation of sacral dorsal root ganglion on bladder reflex in cats9 October 2018 | International Urology and Nephrology, Vol. 50, No. 12The inhibitory effect of sacral dorsal root ganglion stimulation on nociceptive and nonnociceptive bladder reflexes in cats27 January 2018 | World Journal of Urology, Vol. 36, No. 5Dorsal Root Ganglion Stimulation for Pain Control Vol. 6, No. 3 Follow us on social media for the latest updates Metrics Downloaded 120 times History Published online 15 March 2016 Published in print May 2016 Information© Future Medicine LtdKeywordschronic paindorsal root ganglion stimulationneuromodulationneuropathic painsensitizationspinal cord stimulationPDF download