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Muhly WT, Gurnaney HG, Ganesh A. Regional anesthesia for pediatric knee surgery: a review of the indications, procedures, outcomes, safety, and challenges. Local Reg Anesth. 2015;8:85-91doi: 10.2147/LRA.S73458.
Muhly, W. T., Gurnaney, H. G., & Ganesh, A. (2015). Regional anesthesia for pediatric knee surgery: a review of the indications, procedures, outcomes, safety, and challenges. Local and regional anesthesia, 885-91. https://doi.org/10.2147/LRA.S73458
Muhly, Wallis T, et al. "Regional anesthesia for pediatric knee surgery: a review of the indications, procedures, outcomes, safety, and challenges." Local and regional anesthesia vol. 8 (2015): 85-91. doi: https://doi.org/10.2147/LRA.S73458
Muhly WT, Gurnaney HG, Ganesh A. Regional anesthesia for pediatric knee surgery: a review of the indications, procedures, outcomes, safety, and challenges. Local Reg Anesth. 2015 Nov 05;8:85-91. doi: 10.2147/LRA.S73458. eCollection 2015. PMID: 26609245; PMCID: PMC4644165.
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Local Reg Anesth. 2015 Nov 05;8:85-91. doi: 10.2147/LRA.S73458. eCollection 2015.

Regional anesthesia for pediatric knee surgery: a review of the indications, procedures, outcomes, safety, and challenges.

Local and regional anesthesia

Wallis T Muhly, Harshad G Gurnaney, Arjunan Ganesh

Affiliations

  1. Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Pennsylvania, PA, USA.

PMID: 26609245 PMCID: PMC4644165 DOI: 10.2147/LRA.S73458

Abstract

The indications for surgery on the knee in children and adolescents share some similarity to adult practice in that there are an increasing number of sports-related injuries requiring surgical repair. In addition, there are some unique age-related conditions or congenital abnormalities that may present as indications for orthopedic intervention at the level of the knee. The efficacy and safety of peripheral nerve blocks (PNBs) for postoperative analgesia following orthopedic surgery has been well established in adults. Recent studies have also demonstrated earlier functional recovery after surgery in patients who received PNBs. In children, PNB is gaining popularity, and increasing data are emerging to demonstrate the feasibility, efficacy, and safety in this population. In this paper, we will review some of the most common indications for surgery involving the knee in children and the anatomy of knee, associated dermatomal and osteotomal innervation, and the PNBs most commonly used to produce analgesia at the level of the knee. We will review the evidence in support of regional anesthesia in children in terms of both the quality conferred to the immediate postoperative care and the role of continuous PNBs in maintaining effective analgesia following discharge. Also we will discuss some of the subtle challenges in utilizing regional anesthesia in the pediatric patient including the use of general anesthesia when performing regional anesthesia and the issue of monitoring for compartment syndrome. Finally, we will offer some thoughts about areas of practice that are in need of further investigation.

Keywords: analgesia; knee surgery; pediatric surgery; regional anesthesia

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