Will is a good-natured, active boy who loves riding his bike, playing with LEGOs and caring for his family’s two cats. So when he emerged from anesthesia following surgery to release a tethered spinal cord last August, it was clear he wasn’t feeling like himself. “He would be very combative and then very sleepy, explains Kathleen. “I just kept saying, ‘That’s not him.’” Kathleen and her husband, Eric, later learned that Will’s behavior was a consequence of the morphine he was being given to treat his postsurgical pain.
After such a rough recovery, Will and his parents weren’t exactly looking forward to his next procedure, a femoral osteotomy with muscle release and tibial de-rotation. Along with the concern that Will might react poorly to morphine again, they worried about another unpleasant side effect: constipation. Kids with spina bifida often have a condition called neurogenic bowel, or a lack of normal bowel function, which can also cause problems with regularity. Morphine had the potential to make those challenges worse.
Another option for pain
Yet just two weeks before the procedure, the Gustafsons discovered another option for Will, which they hoped might make his experience a little easier. While chatting with a friend whose son had recently undergone surgery, Kathleen learned about regional anesthetics.
These techniques provide a focused anesthetic to a specific part of the body, without requiring a full general anesthetic. They have been shown to improve outcomes in children who have undergone surgery, including fewer side effects, faster recovery and less time in the hospital compared with general anesthesia. They can also limit or eliminate the need for pain medications such as opioid drugs and other narcotics.
“Once we heard about this approach, we were 100 percent onboard,” says Kathleen. She requested that Will receive regional anesthesia during his upcoming procedure.
A sigh of relief
On the day of surgery, Will and his parents met with physicians from the Regional Anesthesia Program at Boston Children’s Hospital, including Dr. Walid Alrayashi, who explained that they would be using nerve blocks to help prevent and treat the boy’s pain. Nerve blocks are single-shot regional anesthetics, which can last anywhere from 12 to 48 hours. This technique would allow Will to skip the morphine and instead receive smaller doses of narcotics and a sedative.
Following the procedure by Dr. Lawrence Karlin, a senior orthopedic surgeon in the Orthopedic Center, the Gustafsons waited to see how their son would react. By the next morning, they were both breathing sighs of relief. “He had an appetite right away and ate a big breakfast — he doesn’t even eat that much at home,” Kathleen remembers. Even better, Will didn’t feel groggy or nauseous. “He was like his old self again,” says his mother.
After five weeks, Will’s cast was off and he was back at school, hanging out with his friends. His diagnosis of spina bifida means he’ll likely return to Boston Children’s in the future for additional surgeries. But when he does, he and his family know that they’ll have a safer option for anesthesia and for a smoother recovery. “This approach has really been a godsend,” says Kathleen.
Learn about the Regional Anesthesia Program.