OKOJ, Volume 13, No. 11

Current Concepts Review: The Use of Regional Anesthesia in Pediatric Orthopaedic Surgery

The use of regional anesthesia in children undergoing surgery is not a new concept, having been pioneered in Europe at the turn of the 19th century. Although there was initial hesitation over potentially “doubling” the anesthetic exposure for children through the use of regional anesthesia in conjunction with general anesthesia, the idea of using regional anesthesia in the pediatric surgical population has gained considerable acceptance over the past 25 years. The term regional anesthesia encompasses a variety of techniques that may most simply be divided into central/neuraxial and peripheral blocks. Regional blocks may be administered through a single dose of anesthetic agent or as a continuous infusion through a temporary catheter. Nerve stimulation and ultrasonographic guidance are two commonly used techniques for the localization of nerves in regional anesthesia. Despite widespread concern over the risk of potentially devastating complications associated with regional anesthesia in the pediatric population, increasing data in the anesthesiology literature appear to demonstrate both its safety and efficacy for children undergoing surgical procedures, including orthopaedic surgery, although robust data in support of the value and quality of care that regional anesthesia permits for pediatric surgical patients are still lacking. Interdisciplinary studies of outcomes with the use of pediatric regional anesthesia, including both surgeons and anesthesiologists, may better inform this ongoing discussion.

    • Keywords:
    • peripheral nerve block

    • central/neuraxial block

    • regional block

    • pain management

    • epidural

    • pediatric analgesia

    • Subspecialty:
    • Pediatric Orthopaedics

Growth-Friendly Techniques for Managing Early-Onset Scoliosis

Progressive early-onset scoliosis results in abnormal pulmonary development that may have a significant effect on the quality and duration of life. Because of this, growth-friendly treatment strategies are used to alter the natural history of such scoliosis and maximize patients’ pulmonary development. These strategies include casting and surgical techniques aimed at avoiding spinal fusion, manipulating growth, and guiding the development of the spine and chest. Serial, derotational casting has become an excellent growth-friendly treatment for curing or containing early-onset scoliosis and preventing progressive deformity. In addition to such casting are fusionless surgical techniques for permitting growth of the spine and thoracic cavity of children with early-onset scoliosis. This article focuses on the technical aspects of casting and dual growing rod instrumentation as two literature-supported options for treating early-onset scoliosis.

    • Keywords:
    • early-onset scoliosis

    • serial cast

    • growth-friendly surgery

    • Subspecialty:
    • Pediatric Orthopaedics

Percutaneous Thermal Ablation Techniques for the Treatment of Musculoskeletal Metastases

Musculoskeletal metastases, particularly those affecting bone, are common and associated with significant morbidity in cancer patients. Percutaneous ablation of soft-tissue and/or bone metastases can provide relief of pain and local disease control for properly selected patients. Although multiple technologies for percutaneous ablation exist, the thermal-based techniques of radiofrequency ablation and cryoablation are the most established and most often used technologies in practice. Focused ultrasound surgery is a noninvasive ablation technique that has shown great promise, but has not yet been incorporated into routine clinical practice. Microwave ablation is another relatively new modality for percutaneous ablation that has shown early promise, but is also not yet routinely used in practice. This article reviews the indications, procedural techniques, and outcomes for percutaneous thermal ablation, specifically radiofrequency ablation and cryoablation, in the management of patients with musculoskeletal metastases.

    • Keywords:
    • image-guided therapy

    • percutaneous ablation

    • radiofrequency ablation

    • cryoablation

    • Subspecialty:
    • Musculoskeletal Oncology

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