Continuous chloroprocaine paravertebral infusions for postoperative analgesia in infants and very young children

Greco, Christine; Boretsky, Karen

doi:10.1111/pan.13962

Cited by 4 publications

(2 citation statements)

References 6 publications

(9 reference statements)

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“…Denser sensory blockade may be beneficial; as such, chloroprocaine may be preferable for continuous peripheral nerve and/or neuraxial anesthesia in pediatric patients, instead of dilute local anesthetics such as 0.1% to 0.2% ropivacaine. 47,48 These wide variations in local anesthetic selection and dosing were also noted in the Pediatric Regional Anesthesia Network's study by Suresh et al which showed a 5-to 10-fold spread in local anesthetic dose variability for the same blocks. 49 Lastly, in nonverbal children, it is challenging for healthcare providers to distinguish pain from other symptoms, such as agitation, hunger, thirst, nausea, constipation, or fatigue, which may result in pain overtreatment.…”

Section: Discussionmentioning

confidence: 80%

“…These limit the duration of single-shot RA techniques and decrease the degree of sensory blockade and pain management expected in children who undergo either single-shot or catheter-based RA techniques, especially when compared with adults. Denser sensory blockade may be beneficial; as such, chloroprocaine may be preferable for continuous peripheral nerve and/or neuraxial anesthesia in pediatric patients, instead of dilute local anesthetics such as 0.1% to 0.2% ropivacaine 47,48 . These wide variations in local anesthetic selection and dosing were also noted in the Pediatric Regional Anesthesia Network’s study by Suresh et al which showed a 5- to 10-fold spread in local anesthetic dose variability for the same blocks 49 .…”

Section: Discussionmentioning

confidence: 99%

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Perioperative Regional Anesthesia Pain Outcomes in Children

Xie,

De Souza,

Perez

et al. 2023

The Clinical Journal of Pain

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Objective: Randomized controlled trials indicate regional anesthesia (RA) improves postoperative outcomes with reduced pain and opioid consumption. Therefore, we hypothesized children who received RA, regardless of technique, would have reduced pain/opioid use in routine practice. Methods: Using a retrospective cohort, we assessed the association of RA with perioperative outcomes in everyday practice at our academic pediatric hospital. Patients ≤18 years undergoing orthopedic, urologic, or general surgeries with and without RA from 5/2014 to 9/2021 were categorized as single-shot, catheter-based, or no-block. Outcomes included: intraoperative opioid exposure and dose, pre-incision anesthesia time, post anesthesia care unit (PACU) opioid exposure and dose, PACU antiemetic/antipruritic administration, PACU/inpatient pain scores, PACU/inpatient lengths of stay, and cumulative opioid exposure. Regression models estimated the adjusted association of RA with outcomes, controlling for multiple variables. Results: 11,292 procedures with 3,160 RAs were included. Compared to no-block group, single-shot and catheter-based blocks were associated with opioid-free intraoperative anesthesia and opioid-free PACU stays. Post-PACU (i.e. while inpatient), single-shot blocks were not associated with improved pain scores or reduced opioid use. Catheter-based blocks were associated with reduced PACU and inpatient opioid use until 24 hours post-op, no difference of opioid use from 24 to 36 hours, and higher probability of use from 36 to 72 hours. RA was not associated with reduced cumulative opioid consumption. Discussion: Despite adjustment for confounders, the association of RA with pediatric pain/opioid use outcomes was mixed. Further investigation is necessary to maximize the benefits of RA.

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Section: Discussionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 99%