Prolonged blockade of the brachial plexus for the early rehabilitation of children with posttraumatic elbow contractures

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Abstract

Objective. Improvement of surgical treatment outcomes in children with post-traumatic elbow contractures. Materials and methods. The study is based on the diagnostic findings of 48 children with post-traumatic elbow contractures who were treated at the Turner Scientific and Research Institute for Children’s Orthopedics. All children underwent complex rehabilitation after reconstructive intra-articular surgery to work out passive motions in the elbow using ARTROMOT-E2 device. The patients of the study group started rehabilitation in the first days after reconstructive intra-articular surgery in the background of prolonged blockade of the brachial plexus. In the control group, the rehabilitation was carried out traditionally on the 6th day after surgery without regional anesthesia. The patients of the study group were supplied with Contiplex SU perinural catheters for prolonged blockade of the brachial plexus using ultrasound (Edge SonoSite) and neurostimulation (Stimuplex® HNS12) before surgery. For perioperative blockade of the brachial plexus we used intermittent injection of 0.5% ropivacaine (2 mg / kg). The severity of pain at the stages of rehabilitation was assessed using 10-point grading scale (FPS-R). The range of active and passive motions in the joints was evaluated by measuring the range of motions with a fleximeter. Results. Intermittent injection of ropivacaine before rehabilitation allowed to correct post-traumatic elbow contractures in children in the first days after surgery associated with the minimum subjective pain level and stable hemodynamic parameteres, accompanied with a significant increase of the elbow motion range in comparison with the group of the patients who were not performed regional anesthesia . Conclusion. Prolonged blockade of the brachial plexus in rehabilitation treatment of children with post-traumatic contractures provides appropriate analgesic and myoneural block components from the 1st day after intra-articular reconstructive surgery. Early rehabilitation provides good results of the treatment and reduces rehabilitation period terms.

About the authors

D. V. Zabolotsky

Turner Scientific Research Institute for Children’s Orthopedics; Saint-Petersburg State Pediatric Medical University

Author for correspondence.
Email: docent-zab@mail.ru
Russian Federation

V. A. Koryachkin

Vreden Russian Research Institute of Traumatology and Orthopedics

Email: noemail@neicon.ru
Russian Federation

M. D. Ivanov

Turner Scientific Research Institute for Children’s Orthopedics

Email: noemail@neicon.ru
Russian Federation

M. S. Nikitin

Turner Scientific Research Institute for Children’s Orthopedics

Email: noemail@neicon.ru
Russian Federation

E. V. Prokopovich

Turner Scientific Research Institute for Children’s Orthopedics

Email: noemail@neicon.ru
Russian Federation

A. A. Savenkova

Turner Scientific Research Institute for Children’s Orthopedics

Email: noemail@neicon.ru
Russian Federation

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