Pain Injection Versus Epidural Anesthesia for Hip Surgery in Pediatric Patients With Cerebral Palsy
Status:
Recruiting
Trial end date:
2027-06-30
Target enrollment:
Participant gender:
Summary
Pain management in pediatric patients presents a difficult challenge. Unlike adults,
pediatric patients often cannot communicate their pain management needs clearly. This is
especially true in patients with cerebral palsy (CP), who often have concomitant
developmental delay, intellectual disability and verbal limitations. Current literature
indicates pain as a common experience for children with CP but has been understudied in this
population. Moreover, inadequate post-operative pain control can result in negative
physiologic and psychological complications and lead to poor surgical outcomes. Currently,
perioperative pain management following orthopaedic procedures in pediatric patients follows
traditional protocols that rely on the administration of opioid medications despite their
known adverse side effects including nausea, vomiting, itching, constipation, urinary
retention, confusion, and respiratory depression.
Epidural anesthesia is a key modality in traditional pain management for pediatric patients
with CP given its proven efficacy in decreasing pain and managing spasticity. Yet,
administering epidural anesthesia in this patient population poses several risks including
damage to preexisting intrathecal baclofen pumps, iatrogenic infection, and technically
demanding insertion given high rates of concomitant neuromuscular scoliosis. Alternatively,
multimodal analgesic injections theoretically offer an efficacious adjunct to traditional
pain management protocols with a lower risk profile. Preliminary data from our study group's
pilot randomized control trial comparing the safety and efficacy of a multimodal surgical
site injection to placebo showed decreased pain scores and narcotic consumption
postoperatively in this patient population. Based on these promising results, the objective
of this randomized control trial is to evaluate the efficacy of a multimodal surgical site
injection compared to epidural anesthesia for postoperative pain control following operative
management of hip dysplasia in pediatric patients with CP.