Acute Pain Management in a Child: A Case Report of 46-Days of Popliteal Sciatic Nerve Catheter

Abstract

Background: The use of perineural catheter for more than 72 hours is rare in perioperative practice, but was especially reported for chronic pain, oncologic related pain or palliative care. The main concern remains the risk of neurological or infectious complication. No guideline clearly specifies the maximum duration of perineural catheter maintenance and the safety of long-term catheters is discussed. Case report: We described the case of an 11-year-old boy who suffered a serious injury on his foot. An ultrasound guided sciatic nerve block was performed, with placement of a non-tunneled perineural catheter. The catheter could be used for 46 days with an excellent efficiency both for analgesia (continuous infusion) and anesthesia (additional bolus for surgical procedure). No infectious or neurological related complication to regional anesthesia was notified. Conclusion: This case demonstrates all the benefits that can be expected by long-term perineural catheter, even if it should be managed with great caution and after careful assessment of the risk-benefit balance. number of days before removal of the catheter with an increased risk after 3 days of catheter maintenance [2]. But only few transient and no major neurologic complications were reported [2]. In pediatric, PNBC are often used for postoperative analgesia after orthopedic or general surgery and are typically removed after only 2-3 days. Long term used of PNBC have yet been described for control of chronic pain, oncologic related pain or palliative care in young adults and children [3-5]. We present the case of a child who required the use of a PNBC over a long period of 46 days for perioperative pain management. The child and his family consented to the anonymous publication of this case. Description of the Case An 11-years-old boy, weighting 38 kg, without medical or surgical history, was admitted to our unit after a motor vehicle-pedestrian trauma. The child presented a faciocranial trauma with an initial loss of consciousness but a Glasgow score of 14 at the arrival of medical assistance. A fracture of the right horizontal branch of the mandibular corpus was diagnosed and treated by surgical osteosynthesis. Moreover, there was a severe injury with a large soft tissue defect extending from the internal malleolus to the second phalangeal of the right hallux and musculotendinous and osseous exposure. No vascular compromise was noted and the limited initial neurological exam was not able to objectify significant nerve injury or deficit. The patient complained of diffuse pain. However, shocked by the accident, it was not possible to assess the level of his pain. It was decided to treat him by sedation-analgesia with ketamine. Surgical CASe RePoRt