Journal of Foot and Ankle Surgery - 2026-07-11 - Journal Article
Clinical Evaluation of Opioid-Free Pediatric Peripheral Nerve Block for Lower Extremity Surgery Without Sedation.
Kim YK, Kang C
Topics
Key Takeaway
Opioid-free peripheral nerve block without sedation achieved a 99% single-attempt success rate in 71 procedures across 58 pediatric patients (ages 8–16) undergoing lower extremity surgery.
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Summary
This retrospective study evaluated the safety and efficacy of unsedated peripheral nerve block for lower extremity surgery in pediatric patients aged 8–16, using parental support and procedural explanation as anxiolysis. Among 71 blocks in 58 patients, the single-attempt success rate was 99% with only one incomplete block and no major complications. CAM-S anxiety scores and VAS pain scores for block placement were higher in the younger pediatric subgroup (mean age 10.0 years) versus adolescents (mean age 14.1 years), but the difference was not statistically significant.
Key Limitation
The retrospective single-center design with no sedated control group makes it impossible to determine whether the 99% success rate is attributable to the unsedated technique, patient selection bias, or operator experience.
Original Abstract
BACKGROUND
Peripheral nerve blocks in pediatric patients are often performed under deep sedation to minimize uncooperative behavior. However, sedation may obscure the accuracy of clinical assessments.
PURPOSE
This study evaluated the clinical safety and efficacy of peripheral nerve block for lower extremity surgery without sedation in pediatric patients.
STUDY DESIGN
Retrospective study
METHODS
This study analyzed 71 peripheral nerve block procedures in 58 pediatric patients who underwent lower extremity surgery without sedation. Clinical outcomes, including Child Anxiety Meter-State score, visual analog scale score, operative time, anesthesia onset time, and complications, were assessed.
RESULTS
Among the cases, 18 were in the pediatric group (mean age 10.0 ± 1.6 years) and 53 in the adolescent group (mean age 14.1 ± 1.2 years). CAM-S scores before PNB and VAS scores for PNB were higher in the pediatric group, but there was no statistical difference. The success rate of peripheral nerve block as a single-attempt procedure was 99%. One case of incomplete block was observed as a complication.
CONCLUSIONS
No major complications were observed in pediatric patients aged 8 to 16 years who underwent peripheral nerve block with detailed explanation of the procedure and parental support. This approach increased the success rate of peripheral nerve block without sedation to 99% in lower extremity surgeries. It represents a new anesthetic option for patients who consent to undergo this procedure.
LEVEL OF EVIDENCE
Level 4.