General principles of regional anaesthesia in children

Merella, F.; Canchi-Murali, Naveen; Mossetti, Valeria

doi:10.1016/j.bjae.2019.06.003

Cited by 23 publications

(12 citation statements)

References 30 publications

(24 reference statements)

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“…Given that the patient postoperatively had a pain intensity of 4 according to the FACE scale, he was given an ibuprofen suppository, after which the pain was adequately controlled according to his clinical signs—he calmed down and fell asleep [ 12 ]. Regional anesthesia can also be performed in children, but it is usually combined with general anesthesia or used as a method of postoperative pain control [ 13 , 14 ]. Considering the specificity of patients with G6PD deficiency, attention should be given to the choice of local anesthetic, because for instance lidocaine and prilocaine are not recommended, while bupivacaine is shown to be safe to use [ 15 , 16 ].…”

Section: Discussionmentioning

confidence: 99%

Management of Anesthesia and Perioperative Procedures in a Child with Glucose-6-Phosphate Dehydrogenase Deficiency

Cicvarić

Tahtler

Vukušić

et al. 2022

JCM

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Glucose-6-phosphate dehydrogenase (G6PD) is an enzyme that helps red blood cells work properly; it participates in the production of antioxidants and helps to defend cells against oxidative damage. With all this in mind, patients with G6PD deficiency may be very sensitive and vulnerable to different oxidative stressors, because they can cause some serious medical conditions of which hemolytic anemia is common in adults and severe jaundice in newborns. The most common triggers of hemolysis in G6PD deficiency are infections, medications, metabolic conditions such as diabetic ketoacidosis, hypothermia, and a very important item—surgical stress. During the operative period, the anesthetic goal is to reduce stress and monitor if the hemolysis occurs, and of course, treat it if it occurs. In our case, the combination of sevoflurane inhalation anesthesia with the addition of sufentanil proved to be safe and effective in the management of a child with G6PD deficiency.

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Section: Discussionmentioning

confidence: 99%

Management of Anesthesia and Perioperative Procedures in a Child with Glucose-6-Phosphate Dehydrogenase Deficiency

Cicvarić

Tahtler

Vukušić

et al. 2022

JCM

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“…and propofol 5-10 mg/ kg/h. [8,9,10] Vital signs (heart rate, blood pressure, saturation, and capnography) were recorded prior performing the peripheral nerve block, during surgery, and 30 min. postoperatively.…”

Section: Methodsmentioning

confidence: 99%

Epinephrine and Dexamethasone as Adjuvants in Upper Extremity Peripheral Nerve Blocks in Pediatric Patients

Mikjunovikj-Derebanova

Карталов

Кузмановска

et al. 2021

Prilozi

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Introduction: Regional anesthesia in children in recent years has been accepted worldwide. The increased interest in it is partly due to the use of ultrasonography which provides confidence and accuracy to the anesthesiologic team. Adjuvants are used to extend the duration of the sensory and motor blocking, limiting the cumulative dose of local anesthetics. The use of adjuvants in peripheral nerve blocks in the pediatric population is still under research. Aim: To observe the effect of epinephrine and dexamethasone as adjuvants to local anesthetics in peripheral upper extremity nerve blocks in pediatric patients. Materials and methods: The study included 63 patients, aged group 4-14 years, admitted to the University Clinic of Pediatric Surgery for surgical treatment of upper limb fractures in the period of January 2020 until March 2021. Patients were randomized into three groups, and all patients in the groups received analgo-sedation prior to peripheral nerve block. Patients in group 1 (21 patients) received supraclavicular, or interscalene block with 2 ml lidocaine 2% and bupivacaine 0.25% (max 2mg/kg) with a total volume of 0.5ml/kg. In group 2, the patients (21) received 25 μg of epinephrine in 2 ml of 2% solution of lidocaine and 0.25% bupivacaine (max 2 mg/kg) with a total volume of 0.5 ml/kg, and in group 3, the patients (21) received 2% lidocaine 2ml and 0.25% bupivacaine (max 2mg/kg) in combination with 2mg dexamethasone with a total volume of 0.5ml/kg. Results: Results showed that in patients in group 1, the average duration of the sensory block was 7 hours, while the duration of the motor block was 5 hours and 30 minutes. In group 2 (epinephrine), the durations of both sensory and motor block were prolonged for about 30 minutes on average compared to the first group. In group 3 (dexamethasone) the duration of the sensory and motor block was significantly longer compared with the first two groups (p<0.0001). Conclusion: Epinephrine and dexamethasone prolong the duration of action of local anesthetics in peripheral nerve blocks of the upper extremity in pediatric patients and thus reduce the need for analgesics in the postoperative period.

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“…Regional anesthesia (RA) techniques are the most valuable and safest methods to treat perioperative pain in children. Notable progress has been made in the development of RA in children over the past few years, including the availability of information on safety, nomenclature, and ultrasound prioritization ( 22 , 23 ).…”

Section: Introductionmentioning

confidence: 99%

Elevated serum TLR4 level as a potential marker for postsurgical chronic pain in pediatric patients with different approaches to analgesia

Semkovych

Dmytriiev²

2022

Front. Med.

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IntroductionThe perioperative period of any surgery is accompanied by immune suppression. The level of Toll-like receptor 4 (TLR4) is known to increase in inflammation and after nerve injury and contributes to the development of neuropathic pain. The interaction of TLRs in response to the effect of opioids results in paradoxical hyperalgesia. Regional anesthesia techniques are the standard of care for perioperative pain management in children.AimThe aim of the study was to determine and evaluate the indicators of TLR4 for different methods of pain relief in anesthetic management of hernia repair in children and their effect on pain chronification.Materials and methodsThere were examined 60 children with inguinal hernia during 2020–2022. Children were divided into 3 groups: Group I included 20 children who underwent surgery under general anesthesia using the block of the anterior abdominal wall—transversalis fascia plane block (TFPB), combined with the quadratus lumborum block (QLB-4) via a single intramuscular injection; Group II included 20 children who underwent surgery under general anesthesia using the TFPB; Group III comprised 20 children who underwent surgery under general anesthesia using opioid analgesics. The levels of TLR4 were evaluated at a discharge from the hospital, 3 and 6 months after surgery.ResultsThere was no difference in age and body weight among all groups. In Group II, boys prevailed. In Group III, the length of hospital stay was the longest (3.28 ± 0.24 days, p < 0.05, t = 4.09) as compared to children of Group II and Group I (3.0 ± 0.30 (p < 0.05, t = 2.647) and 2.1 ± 0.16 days, respectively). While staying in the surgical department, children of Group III demonstrated significantly higher FLACC and VAS scores. The prevalence of chronic pain was the highest among children of Group III (35%) as compared to those in Group II and Group I (20 and 15%, respectively). The highest increase in the level of TLR4 was found in the group of opioid analgesia on the third and sixth months after surgery (68.86 + 10.31 pg/ml and 143.15 + 18.77 pg/ml (p < 0.05, t = 6.33), respectively) as compared to patients who received regional anesthesia.ConclusionsThere were confirmed the following advantages of the transversalis fascia plane block combined with the quadratus lumborum block (QLB + TFPB) via a single intramuscular injection: ease of use; adequate perioperative pain control as evidenced by the FLACC and VAS pain assessment scales; reduced perioperative use of opioid analgesics; shortening the length of hospital stay.

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General principles of regional anaesthesia in children

Cited by 23 publications

References 30 publications

Management of Anesthesia and Perioperative Procedures in a Child with Glucose-6-Phosphate Dehydrogenase Deficiency

Management of Anesthesia and Perioperative Procedures in a Child with Glucose-6-Phosphate Dehydrogenase Deficiency

Epinephrine and Dexamethasone as Adjuvants in Upper Extremity Peripheral Nerve Blocks in Pediatric Patients

Elevated serum TLR4 level as a potential marker for postsurgical chronic pain in pediatric patients with different approaches to analgesia

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