{
  "abstract": "Background and Aims Peripheral nerve catheters are often avoided in trauma due to concerns about masking acute compartment syndrome (ACS) and infection risks. This report describes the successful use of two peripheral nerve catheters for weeks following a traumatic amputation.Methods A 3-year-old, 20-kg boy with no significant comorbidities sustained a traumatic partial amputation of the right lower extremity at the ankle, caused by a lawnmower. Injuries included an exposed talus, open shin and knee wounds, and no exposed bone. He underwent emergent orthopedic washout. Anesthesia was uneventful and he had femoral and sciatic nerve catheters placed for pain control. The femoral catheter infused ropivacaine 0.1% at 8 mL/hr, and the sciatic catheter infused ropivacaine 0.1% at 4 mL/hr. Initial pain control was effective, but the catheters stopped working on postoperative day 7 and were replaced during a repeat washout.Results The replacement catheters provided excellent pain relief for the remaining 20-day hospitalization. Additional medications included gabapentin (100 mg nightly), acetaminophen, diazepam as needed, and oxycodone. At discharge, the patient required only gabapentin (100 mg twice daily). Follow-up showed continued improvement, with gabapentin reduced to 100 mg nightly and steady progress in physical therapy.Conclusions Understanding of ACS and regional anesthesia in children is derived largely from case reports. A retrospective study of 565 pediatric trauma cases demonstrated a 94.9% block success rate in children aged 0–3 years, without anesthesia-related complications. Effective acute pain control is critical to minimizing chronic pain and psychological trauma after amputation. Despite infection concerns, younger children tolerate long-term indwelling catheters well, even with activity. A study of 44,555 patients found similar infection-free rates for continuous nerve catheters at 4 days (99%) and 15 days (73%). With infection surveillance, prolonged catheter use reduces opioid dependence. In this case, the child was discharged on gabapentin alone less than a month after the accident.",
  "authors": [
    {
      "affiliations": [
        "Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, USA"
      ],
      "name": "Walid Alrayashi"
    },
    {
      "affiliations": [
        "Regional Anesthesiology, Boston Children’s Hospital, Boston, USA"
      ],
      "name": "Stuart Pasch"
    }
  ],
  "title": "P101 Long-term use of peripheral nerve catheters after traumatic amputation in a child",
  "uid": "3b9ce4b7-da5d-5277-b0b5-c2ba70bb23f5"
}