Complications in Pediatric Regional Anesthesia

Abstract

Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Complications in pediatric regional anesthesia are rare, so a large sample size is necessary to quantify risk. The Pediatric Regional Anesthesia Network contains data on more than 100,000 blocks administered at more than 20 children’s hospitals. This study analyzed the risk of major complications associated with regional anesthesia in children. Methods This is a prospective, observational study of routine clinical practice. Data were collected on every regional block placed by an anesthesiologist at participating institutions and were uploaded to a secure database. The data were audited at multiple points for accuracy. Results There were no permanent neurologic deficits reported (95% CI, 0 to 0.4:10,000). The risk of transient neurologic deficit was 2.4:10,000 (95% CI, 1.6 to 3.6:10,000) and was not different between peripheral and neuraxial blocks. The risk of severe local anesthetic systemic toxicity was 0.76:10,000 (95% CI, 0.3 to 1.6:10,000); the majority of cases occurred in infants. There was one epidural abscess reported (0.76:10,000, 95% CI, 0 to 4.8:10,000). The incidence of cutaneous infections was 0.5% (53:10,000, 95% CI, 43 to 64:10,000). There were no hematomas associated with neuraxial catheters (95% CI, 0 to 3.5:10,000), but one epidural hematoma occurred with a paravertebral catheter. No additional risk was observed with placing blocks under general anesthesia. The most common adverse events were benign catheter-related failures (4%). Conclusions The data from this study demonstrate a level of safety in pediatric regional anesthesia that is comparable to adult practice and confirms the safety of placing blocks under general anesthesia in children.

Utilization of a Continuous Pericapsular Nerve Group (PENG) Block with an Opioid-Sparing Repair of a Femoral Neck Fracture in a Pediatric Patient

“…Cannulated screw fixation is usually required for older children in whom transcervical fracture is unstable, and the determination of open versus closed approach commonly depends on the success of surgical traction for reduction. Regional anesthetic techniques are safe in children [ 14 – 16 ] and can provide analgesia for pediatric patients undergoing hip surgery [ 3 – 6 ]. Adequate analgesia results in faster rehabilitation, decreased opioid consumption, and avoidance of the untoward side effects associated with opioids.…”

Benefits and Barriers to Increasing Regional Anesthesia in Resource-Limited Settings

“… 7 – 9 In high-resource countries (HRCs), the value of regional anesthesia has been recognized with growing enthusiasm for the past 15 years, but training and adoption of regional techniques have lagged in developing countries despite the many potential benefits that make it particularly suitable for conditions in these countries. 10 , 11 Regional (including neuraxial) anesthesia has been shown to be especially advantageous in obstetric, trauma, and orthopedic patients. These are the very cases that most commonly present for surgery in low-and-middle-income countries (LMICs).…”

Off‐label use of prescription analgesics among hospitalized children in the United States

“…For example, ropivacaine is currently the most widely used local anesthetic for pediatric regional anesthesia in the United States. 33 Ropivacaine's pharmacokinetics, effectiveness, and recommended dosing in infants and children are well established from both investigator-initiated studies and industry-sponsored Phase 4 studies, yet it remains off-label for children of all ages. [34][35][36][37][38] Pediatric data are included in a label only if a supplement is submitted to the original New Drug Application (NDA), a process that must be initiated by product application holders and cannot be performed by the FDA.…”