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Some current controversies in paediatric regional anaesthesia
1Department of Anaesthesiology, Quebec Central University Hospital Sainte-Foy, Quebec, Canada. bdalens@videotron.ca
Current Opinion in Anaesthesiology
|June 1, 2006
Summary
Paediatric regional anaesthesia involves controversial topics, including performing blocks under general anaesthesia and the use of new local anaesthetics. Continuous ropivacaine infusion offers a safe therapeutic index, and ultrasonography is key for catheter placement.
Area of Science:
- Anesthesiology
- Pediatric Medicine
- Pain Management
Background:
- Regional anesthesia in children presents unique challenges and controversies compared to adults.
- The use of general anesthesia during regional blocks and the properties of newer anesthetic agents require careful consideration.
Purpose of the Study:
- To discuss controversial aspects of pediatric regional anesthesia.
- To review recent findings on anesthetic agents, adjuvants, and techniques in pediatric regional anesthesia.
Main Methods:
- Review of current literature on pediatric regional anesthesia.
- Discussion of controversial topics including anesthetic agents, adjuvants, and imaging techniques.
- Analysis of risks such as compartment syndrome masking.
Main Results:
- Regional blocks in anesthetized children are accepted, unlike in adults.
- Levobupivacaine and ropivacaine have distinct pharmacokinetic profiles in infants; continuous ropivacaine infusion is safest.
- Epinephrine, clonidine, and ketamine are advantageous adjuvants; ultrasonography is the preferred technique for catheter placement.
Conclusions:
- Continuous ropivacaine infusion provides the safest therapeutic index in pediatric regional anesthesia.
- Ultrasonography is becoming the gold standard for peripheral catheter placement.
- Monitoring for compartment syndrome is crucial, and adequate pain management aids early diagnosis.
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