P253 Successful use of femoral and sciatic nerve blocks in a pediatric patient with pseudoachondroplasia undergoing bilateral limb lengthening

<h3>Background and Aims</h3> Pseudoachondroplasia is a rare, inherited disorder of bone growth characterized as short-limbed dysplasia associated with axial skeleton abnormality, joint laxity, and early joint pain. The leg is innervated by the femoral nerve branches anteriorly, and sciatic nerve branches posteriorly. Nerve blockade can help stabilize hemodynamics intraoperatively and improve postoperative pain control, which is particularly beneficial for patients with pseudoachondroplasia, who may already experience pre-existing musculoskeletal pain. This paper presents a case of a 10 year old male with pseudoachondroplasia, scheduled for bilateral limb lengthening procedure under total intravenous anesthesia with ultrasound-guided femoral and sciatic nerve blocks. <h3>Methods</h3> After induction, bilateral femoral and mid-thigh sciatic nerves block was done under ultrasound guidance, needle placement confirmed by negative blood aspiration and hydrodissection. Ropivacaine 0.2% five mL was bathed around each nerve, for a total of 20 mL at 1.11 mg/kg/dose. Surgery lasted for 179 minutes without adverse events. <h3>Results</h3> Intra-operatively, patient remained hemodynamically stable. Post-operatively, patient had good pain control with multimodal analgesia consisting of paracetamol, ibuprofen, nerve block, and as needed dose of nalbuphine, with preserved lower limb function. <h3>Conclusions</h3> Despite anatomical challenges, femoral and sciatic nerve block can still be accomplished in patients with pseudoachondroplasia undergoing limb lengthening surgery. Peripheral nerve block, as part of multimodal analgesia, helps to decrease opioid consumption and provides better pain control for this rare and fragile population.