Regional anesthesia for pain relief in children

Abstract

Managing pain in children is a complex area that requires an understanding of the unique challenges offered by this young population. Regional anesthesia is emerging as an adjunct to pain management in children, particularly in the perioperative arena.The following article will assist the practitioner with the management of pain in children through regional techniques. Prior to the presentation of the regional techniques, an overview is presented to address the neurodevelopment of the child, the pharmacologic concerns in the younger patients, and the assessment of pain in the different age groups. Several of the commonly performed regional blocks with appropriate dosing guidelines are reviewed, with an emphasis on blocks that are more unique to the pediatric population.

Perioperative effects of caudal and transversus abdominis plane (TAP) blocks for children undergoing urologic robot-assisted laparoscopic surgery

“…This was unexpected, because caudal blocks generally provide 4-6 hours of analgesia [5], and TAP blocks have been reported to be effective for up to 10 hours [16]. All patients in the present study received IV ketorolac and PO acetaminophen every 6-8 hours following surgery, which likely contributed to the relatively low postoperative opioid use across all treatment groups.…”

“…Standard dosing provides neuraxial blockade of sensory input at and below the T10/umbilical dermatome [5]. The TAP blocks involve injection of local anesthetic into the plane between the internal oblique and transversus abdominis muscles, thereby desensitizing the anterior abdominal wall [6].…”