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Dermatosurgery using subcutaneous infusion anesthesia with prilocaine and ropivacaine in children
1Department of Dermatology, University of Tuebingen, Tuebingen, Germany. matthias.moehrle@med.uni-tuebingen.de
Insights
Subcutaneous infusion anesthesia (SIA) using diluted local anesthetics is a safe and effective pain management technique for pediatric surgical excisions. This method offers an alternative to general anesthesia in children, with ropivacaine providing extended pain relief.
Area of Science:
- Pediatric Surgery
- Anesthesiology
- Dermatology
Background:
- Local anesthesia in pediatric surgery is often limited by injection pain and dose restrictions.
- Subcutaneous infusion anesthesia (SIA) utilizes diluted local anesthetics via infusion pumps to overcome these limitations.
Purpose of the Study:
- To review the safety and efficacy of SIA in children undergoing dermatologic lesion excisions.
- To compare SIA with general anesthesia for pediatric surgical procedures.
Main Methods:
- Retrospective review of 354 pediatric surgical procedures (excision of nevi) performed in 1999.
- Local anesthesia administered via SIA using diluted prilocaine and ropivacaine (0.3%, 0.15%, 0.08%).
- Comparison of patient demographics, procedure sizes, and anesthesia types (SIA vs. general anesthesia).
Main Results:
- SIA was used in 204 children (mean age 9.00 years) for smaller excisions (mean 22 cm2).
- General anesthesia was used in 67 younger children (mean age 3.05 years) for larger excisions (mean 76 cm2).
- No adverse side effects of local anesthesia were reported; ropivacaine provided prolonged postoperative analgesia.
Conclusions:
- Subcutaneous infusion anesthesia is a safe and well-accepted anesthesia method for pediatric surgical procedures.
- SIA can serve as a viable alternative to general anesthesia in select pediatric cases.
- The use of ropivacaine in SIA contributes to extended postoperative pain management.
Abstract:
Pediatric surgical procedures under local anesthesia have been limited by the pain of injections and, because of low body weight, rapidly reached maximum doses. In subcutaneous infusion anesthesia (SIA) highly diluted local anesthetics are administered by flow- and volume-controlled infusion pumps. This article presents a retrospective review of the use of SIA in children undergoing excision of dermatologic problem lesions. A total of 354 surgical procedures, predominantly excisions of nevi in 271 children (3 months-16 years) were performed in 1999: 67 children were operated on under general anesthesia and 204 children with local anesthesia. For local anesthesia we used SIA with diluted prilocaine and ropivacaine (equivalent mixtures of 0.3%, 0.15%, 0.08%). The 67 children operated on under general anesthesia were younger (mean age 3.05 +/- 2.93 years, median age 2.00 years) than the 204 children who had surgery with SIA (mean age 9.00 +/- 4.2 years, median age 9.00 years). The sizes of excisions under general anesthesia were larger (maximum 1060 cm2, mean 76 +/- 225 cm2, median 7 cm2) than those under SIA (maximum 628 cm2, mean 22 +/- 100 cm2, median 3 cm2). No side effects of local anesthesia were observed in these pediatric procedures. The additional use of ropivacaine resulted in prolonged postoperative analgesia. SIA in children is a well-accepted, safe anesthesia that in some cases offers an alternative to general anesthesia.