Local and Regional Anesthesia in Pediatrics
Over the past 30 years, practice of pediatric regional anesthesia and analgesia has expanded rapidly. There are now a substantial number of studies, publications, and chapters in textbooks regarding the techniques, pharmacokinetics, clinical outcomes, and dosing guidelines in children.
Regional anesthesia in children requires special consideration due to generally smaller anatomy and the fact that the vast majority of blocks are administered under general anesthesia or heavy sedation.
Multiple studies of data collected by regional anesthesia centers have found a low incidence of complications in pediatric patients receiving nerve blocks. Permanent or severe complications are extremely rare.
Specific complications that may hinder pediatric nerve blocks include nerve injury, inadvertent dural puncture, improper catheter tip placement, high doses with risk of local anesthetic toxicity, infection, and compartment syndrome.
Ultrasound-guided approaches increase efficacy of blocks and may reduce the risk of complications associated with injection of large volumes of local anesthetic.
As with regional practice in adults, aseptic technique and use of appropriate equipment (e.g., needle size, ultrasound probes) are critical for performance of safe nerve blockade in the pediatric population.
At the end of the chapter, the reader will find some personal suggestions and “pediatric common sense” safety considerations the present author considers necessary for the practice of safe pediatric regional anesthesia.
KeywordsRegional anesthesia in children Central blocks in children Peripheral nerve blocks in children Complications in pediatric regional anesthesia Local anesthetic systemic toxicity in children Ultrasound-guided regional anesthesia in children
Acute compartment syndrome
French-Language Society of Pediatric Anesthesiologists
American Society of Regional Anesthesia and Pain Medicine
Epidural infusion analgesia
Intravenous lipid emulsion
Local anesthetic systemic toxicity
Postdural puncture headache
Pediatric Regional Anesthesia Network
Randomized controlled trials
Transversus abdominis plane
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