Applications of regional anaesthesia in paediatrics

Abstract

Advances in the field of paediatric regional anaesthesia have specific applications to both acute and chronic pain management. This review summarizes data regarding the safety of paediatric regional anaesthetic techniques. Current guidelines are provided for performing paediatric regional techniques, with a focus on applications for postoperative pain management. Brief descriptions of relevant anatomy followed by indications for commonly performed blocks are highlighted along with the potential of adverse side-effects.

Persistent pain following common outpatient surgeries in children: A multicenter study in Italy

“…Kristensen's survey demonstrated a 5% incidence of PPSP in pediatric patients after inguinal hernia repair . Aasvang surveyed adults who had inguinal hernia repair when they were less than 5 years old and 13.5% reported residual pain with 2% reporting moderate to severe chronic pain usually occurring activities . Retrospective surveys have potential for recall bias.…”

“…All study patients received the same basic anesthetic of general inhalation anesthesia, a small amount of opioid, and a preincision regional anesthetic technique. Regional anesthesia techniques offer potential advantages in the prevention of PPSP by preventing the pain stimulus from reaching the central nervous system, decreasing the amount of general anesthesia required, and decreasing pre‐ and postoperative exposure to potentially sensitizing opioids. While we did not individually test for technical success of the regional anesthetic, our experience has been positive and we routinely use regional anesthesia on all surgeries when possible.…”

“…2 Aasvang surveyed adults who had inguinal hernia repair when they were less than 5 years old and 13.5% reported residual pain with 2% reporting moderate to severe chronic pain usually occurring activities. 24 All nonneuraxial blocks were inserted using ultrasound guidance.…”

A Systematic Review and Meta-Analysis of Caudal Block as Compared to Noncaudal Regional Techniques for Inguinal Surgeries in Children

“…It requires the child to be positioned appropriately and is a common practice to administer under deep sedation or a GA. It can cause complications such as needle trauma, infection, haematoma, and inadvertent subarachnoid or intravascular injection of the LA [3]. Other associated adverse effects can include urinary retention and possible motor blockade.…”

Ultrasound Guided Nerve Blocks in Multiple Limb Pediatric Orthopedic Surgery the Changing Times!!

“…It is now a well-known fact that the regional blocks can be performed safely and efficiently without risks of neurological damage. The amalgamation of ultrasound into the practice of regional anaesthesia has perilously improved routine paediatric Perioperative care [4,5]. Ultrasound has the advantage of delivering the right amount of drug at the right place.…”