Each year, some 2,500 children and adolescents come to Hospital for Special Surgery for its unparalleled expertise in pediatric orthopedic surgery. One of the key members of the medical team is the pediatric anesthesiologist, who monitors the child's medical needs throughout the surgical process, ensuring that the child remains safe and comfortable both during surgery and afterwards, during recovery.
"As a pediatric anesthesiologist, you are not only anesthetizing the child, you are caring for the parents as well. Often, parents are more nervous than the child," says Kathryn DelPizzo, MD, assistant attending pediatric anesthesiologist. "You need to relate to both the child and the parents in a stressful situation."
"Something that's been special at HSS for a very long time – for at least 20 years – is that most patients who come here for surgery, including children, have regional anesthesia," says Victor Zayas, MD, director of Pediatric Anesthesiology.
Regional anesthesiology is an umbrella term for techniques that block sensation at the site of surgery without having to put the entire body to sleep. And, because orthopedic surgery is typically focused on a specific limb – excepting spine cases – regional anesthesia is often the ideal option at HSS.
"With regional anesthesia, patients require less overall anesthesia, they wake up faster after surgery, there's less nausea, and they usually don't need as much narcotic medicine for pain after surgery," says Dr. Zayas.
Spinal anesthesia, also called neuraxial, is the most common form of regional anesthesia, involving numbing the lower extremities. Neuraxial anesthesia may be used for a child undergoing surgery on the hip or leg. A local anesthetic is injected near the spinal cord and nerves that connect to the spinal cord to block pain from an entire region of the body. During the procedure, an epidural catheter is inserted which can be used for pain management after surgery.
Another technique, sometimes used in combination with spinal anesthesia, is a peripheral nerve block. In this case, the specific limb or extremity being operated on is numbed. This ultrasound-guided technique is typical for upper extremity surgery in the hand, elbow, and shoulder, and is sometimes used in foot and knee surgeries. Medication supplied through a catheter provides pain relief during the child's hospital stay without the need for narcotics.
Special Surgery's pediatric anesthesiologists conduct research to identify the safest and most effective methods of providing anesthesia and pain relief for children.
Dr. DelPizzo is the principal investigator on a study of neuraxial anesthesia in children ages five to 14 who had surgeries at HSS to evaluate outcomes following neuraxial anesthesia in pediatric patients, specifically the rate of complications such as headaches and transient neurologic symptoms. To date, of the 175 patients surveyed following surgery as part of the study, none have reported any complications or side effects.
Another study, completed in December 2008, looked at the safety and efficacy of using the painkiller acetaminophen intravenously in pediatric patients. Not only does intravenous (IV) acetaminophen act faster than when taken orally or rectally, it also has less variable rates of absorption (which can affect plasma levels and expose small infants to potential toxicity). HSS pediatric anesthesiologists tested the administration of IV acetaminophen in teenagers undergoing spine surgery for idiopathic scoliosis.
This multi-phase, multi-center investigation has led to approval of IV acetaminophen by the U.S. FDA, and HSS will shortly begin using it for those children who cannot take medicines orally.
Learn more in HSS's biannual publication, Discovery to Recovery.