Newer nerve blocks in pediatric surgery

Kaye, Alan D.; Green, Jeremy B.; Davidson, Kelly S.; Gennuso, Sonja A.; Brown, Morgan L.; Pinner, Allison M.; Renschler, Jordan S.; Cramer, Kelsey D; Kaye, Rachel; Cornett, Elyse M.; Helmstetter, John A.; Urman, Richard D.; Fox, Charles J.

doi:10.1016/j.bpa.2019.06.006

Cited by 10 publications

(6 citation statements)

References 30 publications

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“…None of the children developed motor blockade or urinary retention in our study. Our findings are in line with multiple reviews highlighting the safety and efficacy of ultrasound-guided regional nerve blocks and the resulting improvement of perioperative care in children 19 20. There have been two reports of hematoma following QLB in children.…”

Section: Discussionsupporting

confidence: 89%

Ultrasound-guided transverse abdominis plane block, ilioinguinal/iliohypogastric nerve block, and quadratus lumborum block for elective open inguinal hernia repair in children: a randomized controlled trial

Priyadarshini

Behera

Tripathy

et al. 2022

Reg Anesth Pain Med

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Background and objectivesUltrasound-guided ilioinguinal/iliohypogastric (II/IH) nerve blocks and transverse abdominis plane (TAP) blocks are widely used for postoperative analgesia in children undergoing inguinal hernia repair (IHR). Quadratus lumborum block (QLB) provides analgesia for both upper and lower abdominal surgery. Very few randomized controlled trials in children have assessed the efficacy of QLB in IHR. Thus, this study was designed to find the comparative effectiveness of QLB versus TAP and II/IH blocks in children undergoing open IHR.Materials and methodsSixty children scheduled for open IHR were randomly allocated in groups of 20 to receive either ultrasound-guided TAP block with 0.4 mL/kg of 0.25% ropivacaine, II/IH nerve block with 0.2 mL/kg of 0.25% ropivacaine, or QLB with 0.4 mL/kg of 0.25% ropivacaine. Anesthesia was standardized for all patients, and an experienced anesthesiologist performed the blocks after anesthesia induction.Primary outcomeTime to first analgesia.Secondary outcomesPostoperative pain scores, intraoperative and postoperative opioid consumption, cumulative paracetamol usage, block performance time, and block-related complications.ResultsThe median time to first analgesia was 360 (120), 480 (240), and 720 (240) min in the TAP block, II/IH block, and QLB groups, respectively; and was significantly longer in the QLB versus TAP (p<0.001) and II/IH (p<0.001) groups. The time to first analgesia was not significantly different between the TAP and II/IH groups (p=0.596). The mean postoperative tramadol consumption was 11 (12.7), 4 (7.16), and 3 (8) mg in the TAP, II/IH, and QLB groups, respectively (p=0.023); and it was lowest in the QLB group. No significant differences were found between the groups for other secondary outcomes.ConclusionsQLB provides a prolonged period of analgesia and leads to decreased opioid consumption compared with TAP blocks and II/IH nerve blocks in children undergoing open IHR.Trial registration numberCTRI/2019/09/021377.

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Section: Discussionsupporting

confidence: 89%

Ultrasound-guided transverse abdominis plane block, ilioinguinal/iliohypogastric nerve block, and quadratus lumborum block for elective open inguinal hernia repair in children: a randomized controlled trial

Priyadarshini

Behera

Tripathy

et al. 2022

Reg Anesth Pain Med

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“…Local anesthetics have a membrane-stabilizing effect at the neuromuscular junction that acts in synergy with neuromuscular blockers to reduce lactic acidemia and attenuate bronchial hyper-reactivity [54]. The use of loco-regional anesthesia decreases the need for intraoperative opiate administration and its associated side effects, while improving patient outcomes [1,125,130].…”

Section: Anesthetic Technique Monitoring Of Anesthesia Depth Neuromus...mentioning

confidence: 99%

Pediatric robotic surgery: issues in management—expert consensus from the Italian Society of Pediatric and Neonatal Anesthesia and Intensive Care (SARNePI) and the Italian Society of Pediatric Surgery (SICP)

et al. 2022

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Background Pediatric robotic-assisted surgeries have increased in recent years; however, guidance documents are still lacking. This study aimed to develop evidence-based recommendations, or best practice statements when evidence is lacking or inadequate, to assist surgical teams internationally. Methods A joint consensus taskforce of anesthesiologists and surgeons from the Italian Society of Pediatric and Neonatal Anesthesia and Intensive Care (SARNePI) and the Italian Society of Pediatric Surgery (SICP) have identified critical areas and reviewed the available evidence. The taskforce comprised 21 experts representing the fields of anesthesia (n = 11) and surgery (n = 10) from clinical centers performing pediatric robotic surgery in the Italian cities of Ancona, Bologna, Milan, Naples, Padua, Pavia, Perugia, Rome, Siena, and Verona. Between December 2020 and September 2021, three meetings, two Delphi rounds, and a final consensus conference took place. Results During the first planning meeting, the panel agreed on the specific objectives, the definitions to apply, and precise methodology. The project was structured into three subtopics: (i) preoperative patient assessment and preparation; (ii) intraoperative management (surgical and anesthesiologic); and (iii) postoperative procedures. Within these phases, the panel agreed to address a total of 18 relevant areas, which spanned preoperative patient assessment and patient selection, anesthesiology, critical care medicine, respiratory care, prevention of postoperative nausea and vomiting, and pain management. Conclusion Collaboration among surgeons and anesthesiologists will be increasingly important for achieving safe and effective RAS procedures. These recommendations will provide a review for those who already have relevant experience and should be particularly useful for those starting a new program.

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“…Ultrasound-guided thoracic wall blocks [19][20][21] include erector spinae blocks, retrolaminar blocks, Pectoral (PECS) I and II blocks, serratus anterior plane, intercostal blocks and parasternal intercostal plane blocks. (Figure 1, Table 1) These are all fascial plane blocks that rely on the passive spread of local anesthetic to target nerves within the same plane or in adjacent tissue compartments.…”

Section: Thor Acic Painmentioning

confidence: 99%

“…16 Paravertebral blocks are placed in the triangular-shaped potential space adjacent to the spine, with the parietal pleura as anterolateral border and the transverse process and costotransverse ligament posteriorly. 18,21 The dorsal and ventral rami of the spinal nerve roots, the rami communicantes and sympathetic chain are located within this space. A unilateral paravertebral block has less pronounced hemodynamic effects.…”

Section: Thor Acic Painmentioning

confidence: 99%

Thoracic regional anesthesia and the impact on ventilation

Bösenberg

Holland

2022

Pediatric Anesthesia

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Thoracic surgical incisions can be associated with intense pain or discomfort.Postoperative thoracic pain may be multifactorial in origin. Inadequate analgesia causes respiratory dysfunction. Adequate analgesia preserves pulmonary function and may hasten recovery. Intravenous opioids are widely used but sufficient analgesia is seldom achieved in doses that permit safe spontaneous ventilation. Thoracic regional anesthesia provides profound analgesia, is opiate sparing and has minimal depressant effects on ventilation. Thoracic regional anesthesia is both an effective alternative to systemic analgesics or can be used as part of a multimodal analgesic technique.

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Newer nerve blocks in pediatric surgery

Cited by 10 publications

References 30 publications

Ultrasound-guided transverse abdominis plane block, ilioinguinal/iliohypogastric nerve block, and quadratus lumborum block for elective open inguinal hernia repair in children: a randomized controlled trial

Ultrasound-guided transverse abdominis plane block, ilioinguinal/iliohypogastric nerve block, and quadratus lumborum block for elective open inguinal hernia repair in children: a randomized controlled trial

Pediatric robotic surgery: issues in management—expert consensus from the Italian Society of Pediatric and Neonatal Anesthesia and Intensive Care (SARNePI) and the Italian Society of Pediatric Surgery (SICP)

Thoracic regional anesthesia and the impact on ventilation

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