Long-term Complications From Peripheral Nerve Blocks After Pediatric Orthopaedic Lower Extremity Procedures: A Systematic Review

Background: Peripheral nerve blocks (PNBs) are frequently utilized as a regional anesthetic in pediatric orthopaedic surgery for postoperative pain control and reduced time to discharge; however, short- and long-term complications after these procedures are variably reported. Purpose: To identify the frequency of long-term complications in pediatric patients who received regional anesthesia for a lower extremity orthopaedic procedure. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic literature search was performed using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Data were collected on pediatric patients, which included the following: block type, block location, procedure type, patient age, experimental design, and reported outcomes. Full texts were then thoroughly examined to determine whether the article made specific references to long-term (≥6 weeks) complications in pediatric patients who received PNBs. Results: A total of 158 studies were assessed for eligibility. There were 16 of 158 (10%) studies that met inclusion criteria of having a discussion on follow-up to evaluate for long-term complications (≥6 weeks) from pediatric PNBs. Of these 16 studies, 9 documented long-term complications, while 7 reported no complications. The most common complications were motor deficits, chronic pain, reduced range of motion, and neurological paresthesia. Of the 9 studies reporting long-term complications related to PNBs, 16 of 352 patients across 2 studies (5%) reported chronic pain, 45 of 466 patients across 4 studies (10%) reported strength deficits, 16 of 135 patients across 2 studies (12%) reported reduced range of motion, and 11 of 15,387 patients across 4 studies (0.07%) reported sensory deficits. Conclusion: Persistent complications occurred in pediatric orthopaedic patients undergoing lower extremity procedures with PNBs; however, reports in the current literature were rare.