role of regional anaesthesia in major limb operations in children with cerebral palsy

Abstract

There are several issues that influence the anaesthetic care of children with cerebral palsy such as sei-zures, spasticity, and sensitivity to pain medications, scoliosis, mental retardation, inability to communicate, respiratory infections, variable patterns of breathing, excessive drooling and other associated medical condi-tions. A series of 62 cases of cerebral palsy scheduled for limb deformity correction is described. Midazolam 0.5mg.kg -1 was given orally half an hour prior to induction. Glycopyrrolate 0.02 mg.kg -1 IV was administered. Propofol 3 mg.kg -1 was given to facilitate LMA placement. They breathed nitrous oxide and oxygen spontaneously through the LMA. Subsequent to this, infusion of propofol 2 mg.kg -1 .min -1 was com-menced. They received regional blocks such as continuous lumbar epidural for bilateral lower limb proce-dures, continuous sciatic& fascia iliaca compartment block for unilateral lower limb procedures and single shot infraclavicular block for upper limb, for below the elbow surgeries . Adequacy of the block was assessed by the necessity of any rescue analgesic, recovery was evaluated by Alderte score on table, and the time of first feed was noted. Postoperative analgesia was assessed by CHEOPS pain score. Aldrete score was 8 (SD=0.7) by the end of plaster application. Additional drugs for the analgesia were not required in any of the patients. First oral feed was possible 1 ½ hr (SD=1.1) after the procedure. CHEOPS score of 4-6 (Satisfactory levels of analgesia) was achieved into the postoperative period by top ups.