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A New Era for Regional Anesthesia

Facing yet another surgery for a hereditary bone disorder, 12-year-old Mary Kaitlyn Hadley faced, as well, the uniquely miserable side-effects of post-operative pain relief. The opioids given to ease Kaitlyn’s pain after prior surgeries had caused pronounced lethargy and prolonged debilitating nausea, leading to admissions to the hospital to treat. So, a pediatric team at Johns Hopkins Children’s Center embarked on a different – and more modern – approach to controlling her pain, and one that made all the difference.
 
When Kaitlyn returned to Johns Hopkins Children’s Center last June for her fifth surgery to remove tumors that, with her disorder, continue to grow on developing bones – including those in the arms, legs and chest, pediatric orthopaedic surgeon Michael Ain set out to improve her post-operative experience.
 
With Johns Hopkins pediatric anesthesiologist Robert S. Greenberg, he proposed to Kaitlyn’s parents the use of a specific nerve block to spare her the debilitating consequences of the post-surgical opioids. After removing the bony defects in her leg, the surgical team would deliver a regional anesthetic, treating the pain only in the area of her operation.
 
Orthopedic surgeons have long been concerned that regional anesthetics, like a nerve block, could obscure – for the child and physician alike – the occurrence of a serious problem post-surgery, such as a build-up of swelling and pressure in the limb that could end up stopping normal blood flow. The numbing effect of the nerve block might mask the discomfort that would signal such a problem. But in Kaitlyn’s case, technology and expertise at Johns Hopkins were on her side, and her response to traditional opioids made a new approach essential.
 
With advanced ultrasound technology and new local anesthetic drugs, Johns Hopkins pediatric anesthesiologists can now precisely identify and numb specific nerves. “Kaitlyn and her parents felt this might be the answer to the cycle of pain, opioids, nausea, vomiting and readmission, if only we could treat the pain well,” says Greenberg.
 
The result was “a phenomenal change,” says Kristie Hadley: “Our daughter came out of surgery beautifully. The nerve block did wonders. It stopped all her pain for about 24-hours. Without the other pain medicines, she wasn’t nauseated, she had an appetite and was soon ready to see her friends. At home, she needed only a little ibuprofen. The next time we’re here, we are definitely asking for the block again.”
 
While regional pain relief like nerve blocks is growing in popularity among surgeons, best practices for children and adults continue to develop, improve and expand. “We’ve moved into the 21st century with the use of ultrasound regional therapies,” says Greenberg, “and are training others in their use and application.”
 
At Johns Hopkins, he continues, “we are fortunate to have a team focused on taking whatever steps are necessary to improve the patient experience. This case highlights our commitment here continually to change the way we practice medicine to help the kids and families in our care.”
 
Today, in her home in Martinsburg, West Virginia, Kaitlyn is back to playing basketball and lacrosse and enjoying life with friends and family. “Everyone at Johns Hopkins was just wonderful and willing to do whatever it took to make this better for her,” says her mother, “and for us as a family.”
 
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