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Publication Date

5-2021

Abstract

Introduction: Children with cerebral palsy (CP) often undergo musculoskeletal surgeries throughout their developmental years. Historically, standard of treatment for these patients utilizes an epidural catheter post-operatively along with valium and narcotic as needed for analgesia. Epidural catheter placement in this patient population may not always possible or safe, and having an epidural catheter may decrease mobility and prevent the initiation of physical therapy. In a collaborative effort to improve the patient experience, an enhanced recovery after surgery (ERAS) protocol was developed utilizing peripheral nerve blocks instead of epidural catheters. We hypothesize that by eliminating the use of epidural catheters, patients will be able to be mobilized earlier, pass physical therapy sooner and as a result have a decreased length of hospital stay.

Methods: This IRB approved cohort study has a primary objective of assessing the effectiveness of our ERAS protocol versus non-ERAS in CP patients undergoing bilateral multilevel lower extremity surgeries. 10 consecutive CP patients from June to Sept 2021 undergoing surgery were compared with controls from 2018 to 2020 matched by Gross Motor Function Classification System (GMFCS) score, procedure performed and age. Data collected included type regional/neuraxial anesthesia performed, post-operative need for patient-controlled anesthesia (PCA), narcotic use, valium use, and length of stay.

Results: There were 10 patients in both the control group and the ERAS group. The average GMFCS in the control and ERAS group was 4.20. Post-operative narcotic use in morphine equivalents in the ERAS group was 0.26 mg/kg compared to 0.54 mg/kg in the control group. Post-operative valium use was 0.64 mg/kg in the ERAS group versus 0.60 mg/kg in the control group. Post-operative need for a PCA was zero in the ERAS group compared to 4 in the control group. Post-operative discharge from physical therapy was 1.70 days in the ERAS group versus 2.44 days in the control group. Length of stay was on average 2.20 days in the ERAS group compared to 3.00 days in the control group. (Table 1)

Conclusion: The primary difference for a patient in the ERAS pathway is receiving peripheral nerve blocks instead of an epidural catheter. In the ERAS group there was a decrease in the post-operative narcotic consumption and the average length of stay. By replacing an indwelling epidural catheter with regional anesthesia peripheral nerve blocks at the beginning of the surgery, this ERAS protocol has the potential to improve patient outcomes and improve the patient/family experience.

Document Type

Poster

Enhanced Recovery After Surgery (ERAS) Vs Traditional Care In Pediatric Cerebral Palsy Patients Undergoing Bilateral Multilevel Lower Extremity Orthopedic Surgery: A Pilot Study

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