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Pain in Infants with Obstetrical Brachial Plexus Palsy Following Primary Microsurgical Reconstruction
Kristen M Davidge, MD, MSc, FRCS(C); Tiffany Lee, BSc; Emily S. Ho, BSc OT Reg (Ont), MEd; Derek Stephens, MSc; Howard M. Clarke, MD, PhD; FRCS(C)
The Hospital for Sick Children, Toronto, ON, Canada
Purpose: Pain in children with obstetrical brachial plexus palsy (OBPP) is under-appreciated and not well understood. Objective evaluation of pain in infants with OBPP is needed to better understand longitudinal trajectories of pain experienced by this population. The purpose of this study was to evaluate postoperative pain in infants with OBPP undergoing microsurgical reconstruction.
Methods: A retrospective cohort study was conducted of infants with OBPP undergoing microsurgical reconstruction of the brachial plexus between 2001 and 2015. Postoperative pain was evaluated using the well-validated Face, Legs, Activity, Cry, Consolability (FLACC) scale, as well as opioid requirements. FLACC scores and opioid requirements were compared in patients with upper plexus palsy versus total plexus palsy.
Results: 159 infants were evaluated: 60 (38%) with upper plexus and 99 (62%) with total plexus palsy. Mean age at the time of surgery was 6.8 ± 3.1 months. The overall mean and median of the FLACC scores were 0.8 ± 1.9 and 0 for all observations (n=3213 scores). Both the median and the distribution of FLACC scores did not statistically differ between postoperative days 1 through 8. The proportion of FLACC scores > 0 was not statistically different between infants with total versus upper plexus palsy. The overall mean and median of opioid requirements from the post-anaesthesia care unit to postoperative day 2 were 4.5 ± 1.9 mg and 4.2 mg, respectively. After adjusting for patient weight, there was no significant difference in opioid requirements between patients with total versus upper plexus palsy.
Conclusions: Objective assessment of infants with OBPP who had microsurgical reconstruction indicated that these infants have minimal to no pain in the immediate postoperative period. There was no difference in pain experienced by infants with upper versus total plexus palsy.
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