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A retrospective review of pain control in children undergoing sclerotherapy with or without a peripheral nerve block
Sclerotherapy has been increasingly utilized for the treatment of vascular and lymphatic malformations. The procedure may cause significant pain postoperatively, but should improve once vascular bed destruction is complete. For children, the intense pain experienced may lead to increased anxiety with future treatments. We performed a four-year retrospective chart review to determine the effect of regional anesthesia for analgesia during the immediate postoperative period.
Materials and Methods
This study was approved by the Indiana University IRB (#1610870092). A total of 467 patients were identified who had a sclerotherapy procedure performed between 1/1/2012 and 10/1/2016 at Riley Hospital for Children. The two groups analyzed were patients who received sclerotherapy plus a regional block and those who received sclerotherapy only. The sclerosing agents used included: doxycycline, sotradecol, 98% alcohol, and/or ethiodol. Primary end points were total dose pain medication given and highest PACU pain score. Secondary data points include: age, gender, block performed, location of lesion being treated, and administration of decadron and ketorolac.
We identified 437 patients total, 227 patients received a peripheral nerve block and 210 did not receive a peripheral nerve block. For the analyses of each predictor individually, regional block was associated with lower total pain medication (p<0.001) and lower pain score (<0.001). Gender was not associated with pain medicine dose or pain score. In multivariable regression analysis, regional block was still significantly associated with lower pain medication doses and pain score.
Sclerotherapy can be quite painful for the first 24 hours after treatment. For parents, the issue of pain control at home can be difficult and stressful. This retrospective analysis shows, regional blockade provides effective pain management during the early post procedure period and reduces the need for opioid analgesics. Limitations to our study include the retrospective method and follow-up limited to the immediate post-procedure period. Further studies will be prospective study with standardized anesthetic management, longer post-procedure follow-up, and documentation of type and dosage of sclerosing agent used.
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2. Nehra D, Jacobson L, Barnes P et al. (2008) Doxycycline sclerotherapy as primary treatment of head and neck lymphatic malformations in children. J Pediatric Surg 46(11):2083-95