Pediatric anterior cruciate ligament surgeries and length of stay
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Objective: To determine the efficiency of nerve blocks in decreasing length of stay and verbal pain scores postoperatively in pediatric and adolescent patients undergoing anterior cruciate ligament (ACL) surgery. Design: A retrospective chart review of approximately 900 patients that underwent ACL surgery at Children's Hospital Boston and Waltham between the years of 2007 and 2010 was conducted. Patients' American Society of Anesthesiologists physical classification system number, weight, gender, birthday, length of stay, verbal pain scores, blocks given and local analgesics within them, complications, Emergency Department visits, graft type, readmission rates, and if the stay was extended or not was collected. Kruskai-Wallis tests were run to test if the control group (those without nerve blocks) and those with nerve blocks had statistically different significances between pain scores and length of stay. Results: Including all patients, the mean length of stay was 22.37 hours with a minimum stay of 3.75 hours and a maximum stay of 103.9 hours. The majority of patients had ASA's of one (77.3%), with a smaller percentage having a score of two (22.2%) and three (0.5%). The most prevalent graft type used was the hamstring tendon autograft (67%). There was a statistically significant difference p less than .001 in the median length of stay between graft types, with the patellar tendon graft having the lowest length of stay. The most common type of block given was the femoral block which was given in 70.5% of cases, followed by the femoral-sciatic (17.2%), femoral/lateral femoral cutaneous (2.3%), femoral catheter (1.7%), fascia iliac (1.7%), femoral block with femoral catheter (0.5%), sciatic block with femoral catheter (0.3%), and femoral-sciatic block with femoral catheter (0.1%). Although there was no statistically significance in pain scores (p value =.940), or in length of stay (p value =0.110) between those who received blocks and those that did not; there was a statistically significant difference in both pain scores, p less than 0.004, and length of stay p less than 0.001 between the types of blocks given. Those who received femoral-sciatic blocks had the shortest median hospital stay (8.76 hours) within the group of patients that received the nerve blocks. Besides there being no statistically significance difference in length of stay between those that received blocks and those that did not, there was also no difference in rates of extended stay between those who received blocks and those that did not (p value =0.171) or between the types of blocks given (p score =0.161). When looking at the local anesthetics used in the blocks those who received ropivacaine had lower median pain scores than those receiving bupivacaine (p value =.025); however, the median length of stay was the same regardless of the anesthetic used (p value =0.518). There was no statistically significant difference in complications between those receiving blocks and those not (p value =0.163) or between block types (p value =0.217). The same is true with ED visits. Conclusions: Although our hypothesis that those who had blocks would have lower pain scores and lengths of stay compared to those not given blocks was proven wrong, the results do lead to the possibility of studies comparing the effectiveness of instead using femoral-sciatic blocks, especially in non-allograft cases. In addition, an extension of this study is currently underway with more controls to see if there is a difference between those given blocks and those who were not in length of stay that was not detected in our study.
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