Peripheral catheter techniques

Abstract

With ultrasound, continuous peripheral nerve blocks (CPNBs) are one of the most recent developments in regional anesthesia in children. CPNBs are now used more widely in children because more suitable materials have been marketed, allowing complete, and prolonged postoperative pain control. Their use after orthopedic procedures in children and treatment for complex regional pain syndrome in adolescents has demonstrated the benefits. Perineural catheters have also shown their superiority over other techniques of continuous regional anesthesia in terms of side effects. The efficiency and the safety of these techniques may facilitate early ambulation with improved pain management, treatment at home with disposable pumps, and improved rehabilitation of children. Studies on large cohorts of patients published to date have failed to highlight any severe complications in their use compared with other adult studies. Accidents owing to systemic toxicity are very unlikely if the recommended maximum dose is not exceeded. The safety of continuous regional anesthesia techniques in children relies on the use of low-concentration l-enantiomer solutions (ropivacaine or levobupivacaine) accompanied by low plasma concentrations of local anesthetics, limiting the risk of systemic toxicity of these molecules. CPNB can ensure strong and lasting analgesia in hospital or at home.

Home peripheral nerve catheters: the first 24 months of experience at a children’s hospital

“…Systemic toxicity of local anesthetics can occur after administration of an excessive dose, with rapid absorption, or because of an accidental intravenous injection 10. Early signs of neurologic toxicity can include metallic taste, tinnitus, and malaise 11. Our one patient with a metallic taste in his mouth in the PACU received a total of 125 mg (1.44 mg/kg) of ropivacaine in an interscalene block, which is significantly less than the maximum dose limit.…”

The effect of continuous interscalene brachial plexus block with 0.125% bupivacaine vs 0.2% ropivacaine on pain relief, diaphragmatic motility, and ventilatory function

“…Had we used 0.125% ropivacaine (as opposed to 0.2%), there may have been a difference with 0.125% bupivacaine. However, the studied concentrations were chosen because they are most commonly used in regional anesthesia [7,8].…”

“…Two years later, as ropivacaine became more widely available, others chose to evaluate the safety and efficacy of 0.2% ropivacaine for continuous interscalene infusions [6]. To date, published reviews show that most studies use either of those formulations [7,8]; and although it is known that, for epidural labor analgesia [9], the ratio of ropivacaine to bupivacaine potency is 0.6, there have been no studies comparing the effects of these 2 drugs and concentrations in CPNBH, particularly on pain relief and on major adverse effects.…”

Local Anesthetic Injection Speed and Common Peroneal Nerve Block Duration

“…Durations were median [range]: 11 [6][7][8][9][10][11][12][13][14], 12 [9-14], 10.5 [2-15], 11 [8][9][10][11][12][13][14][15][16][17], and 12 [9-18] hours, respectively (P = 0.294). In addition, we found no differences in secondary outcomes.…”

“…2,3,12 Optimizing injection speed could augment the spread of LA toward the targeted nerves, but whether injection speed affects peripheral nerve block characteristics remains to be investigated.…”