Anesthesia and Postoperative Pain Management in Hip Reconstructions in Children With Neurodevelopmental Conditions: A Proposal for a Peri‐ and Postoperative Pain Management Protocol

ABSTRACT Progressive hip displacement is a common problem in children with neurodevelopmental conditions, often leading to painful dislocation and impaired function. Hip reconstruction may be necessary to maintain containment but these reconstructions are major surgery in this vulnerable population. Effective pain management during and after hip reconstruction is crucial but challenging due to comorbidities and communication difficulties. Current practices vary widely, risking inadequate pain control. Epidural analgesia shows superior outcomes compared to local anesthesia, though optimal regimens remain unclear. This study aims to evaluate pain protocols used during and after hip reconstruction and propose a uniform protocol. This retrospective study analyzed records of children with neurodevelopmental conditions who underwent hip surgery at Erasmus MC from 2017 to 2021. Data included surgical details, pain management during and after the operations and pain scores using various validated tools. Pain assessments considered developmental level, using observational scales for non‐verbal children and self‐reports for others. Ninety‐one patients were included. Epidural analgesia was the main method of analgesia in 81 patients (89.0%). The group of patients who received intermittent epidural boluses after the loading dose had a higher number of high pain scores on the day of surgery, compared to those receiving continuous epidural infusion ( p = 0.045). Patients who had undergone previous surgery had significantly higher median pain scores on the day of surgery compared to patients undergoing their first operation ( p = 0.020). This study shows a wide variety in perioperative pain management. Patients who received intermittent epidural boluses instead of continuous epidural infusion during anesthesia experienced higher pain scores on the day of surgery. Next to that, patients who had undergone previous surgery experienced higher pain scores on the day of surgery, suggesting pain sensitization. This study has led to the development of a new uniform protocol.