The role of anticonvulsant drugs in regional anaesthesia for hip surgery in children with cerebral palsy and concomitant epilepsy

Children with cerebral palsy (CP) typically suffer from epileptic seizures as a co-occurring condition to be addressed with antiepileptic drugs (AED) on a long-term basis. The incidence of coagulation disorders related to AED in children with CP is evaluated to range from nearly 4% to 20.7%. Surgery at the hip in CP children requires prolonged epidural analgesia that can be associated with serious adverse events such as epidural hematoma. The evidence for the use of continuous peripheral nerve blockade in children with CP, however, is limited. Purpose To evaluate the effect of AED on hemostasis and safe use of regional anaesthesia techniques at hip surgery in children with CP and concomitant epilepsy. Material and methods A prospective randomized study included 45 children with CP who underwent surgical treatment for spastic hip displacement. According to a type of anesthesia used and a co-occurring condition diagnosed, patients were allocated into 3 groups of 15 participants each: PEA group (control), children with no history of epilepsy receiving prolonged epidural analgesia (PEA); PEA-E group, children with epilepsy receiving AED and PEA; CFSB-E group, children with epilepsy receiving AED and a continuous femoral plus single-shot sciatic nerve block. Hemodynamic and laboratory findings, a need for blood components and complications were evaluated. Results A preoperative fibrinogen level was significantly higher in controls (PEA group), whereas PEA-E and CFSB-E patients showed reduced levels of circulating fibrinogen, prolonged aPTT and decreased coagulation index with negative values measured during major surgical phase. Conclusion Although basic anticonvulsant therapy with use of AED in children with cerebral palsy has been found to be associated with tendency to hypocoagulation evaluated with laboratory tests, neither clinically significant coagulopathy nor a greater risk of hemorrhagic complications have been identified with use of regional anaesthesia at hip joint operations.