Application of regional anesthesia in pediatric hip surgery for developmental dysplasia of the hip: A retrospective observational study.

内容摘要

Background and objectiveDevelopmental dysplasia of the hip is a common musculoskeletal condition in children. Although surgery is often required, the use of general anesthesia can lead to complications that may delay recovery. Regional anesthesia offers a means of reducing these risks; however, its use in children is often limited by challenges in patient cooperation. At our institution, regional anesthesia has been routinely employed for these procedures. This study retrospectively reviewed data from children who underwent surgery for developmental dysplasia of the hip under regional anesthesia over the past 6 years, stratified by age group. The aim was to provide evidence regarding the optimal anesthetic approach for these procedures.MethodsA comprehensive database was established comprising 1254 pediatric patients who underwent surgery for developmental dysplasia of the hip between 1 January 2018 and 31 December 2023. The study included children classified as American Society of Anesthesiologists physical status I-II, who were categorized into three age-based groups: (a) low age (Group L, 0-36 months); (b) middle age (Group M, 36-96 months); and (c) high age (Group H, 96-156 months). The primary outcome was the use of regional anesthesia across the three groups, including the overall utilization rate and the distribution of specific regional anesthesia techniques. Secondary outcomes included anesthetic and surgical characteristics, including anesthesia methods, anesthesia duration, postanesthesia recovery time, surgical procedures, operative duration, intraoperative blood transfusion rates, and hemoglobin levels before and after surgery.ResultsWe analyzed 1254 pediatric patients with developmental dysplasia of the hip and found that 99.8% received general anesthesia, 64.4% received regional anesthesia, and 64.2% underwent combined general and regional anesthesia. Group M included the largest number of patients, whereas Group H had the highest rate of regional anesthesia utilization (P&#x2009;<&#x2009;0.05). Regarding regional anesthesia techniques, caudal anesthesia was the most commonly used in Group L, whereas the fascia iliaca compartment block was increasingly used in Groups M and H (P&#x2009;<&#x2009;0.05). Combined intravenous-inhalational anesthesia with mechanical ventilation was predominantly used in Groups L and M (P&#x2009;<&#x2009;0.05). The use of sevoflurane for general anesthesia was highest in Group L and gradually decreased in Groups M and H (P&#x2009;<&#x2009;0.05). Although surgical complexity increased with age, as reflected by more complex procedures, higher intraoperative blood transfusion rates, and longer anesthesia, and operative durations (P&#x2009;<&#x2009;0.05), Group H had a shorter postanesthesia recovery time than Groups L and M (P&#x2009;<&#x2009;0.05). The high utilization of regional anesthesia in Group H was associated with improved postoperative recovery in children undergoing surgery for developmental dysplasia of the hip and was consistent with the principles of Enhanced Recovery after Surgery.ConclusionRegional anesthesia is widely used in pediatric orthopedic hip surgery. However, the choice of regional anesthesia technique varies considerably with patient age, reflecting differences in anesthetic requirements and surgical characteristics. Younger children most commonly receive caudal anesthesia, whereas older children are more frequently managed with alternative regional techniques, including the fascia iliaca compartment block, lumbar plexus block, and quadratus lumborum block.