Regional anaesthesia in neonates, infants and children: an educational review

Area of Science:

• Pediatric Anesthesiology
• Pain Management
• Regional Anesthesia

Background:

• Prophylactic analgesia using local anesthesia is a common and safe practice in pediatric care.
• Regional blocks in anesthetized children are well-accepted and safe.
• Pediatric patients exhibit distinct pharmacokinetic profiles for local anesthetics compared to adults.

Purpose of the Study:

• To review the principles and practices of regional anesthesia in pediatric patients.
• To highlight effective techniques and considerations for local anesthetic use in children.
• To discuss the role of ultrasound and specific agents in pediatric pain management.

Main Methods:

• Review of current literature on pediatric regional anesthesia.
• Discussion of pharmacokinetic differences in children versus adults.
• Evaluation of specific techniques like caudal anesthesia and peripheral nerve blocks (e.g., transverse abdominis plane, ilio-inguinal nerve block).

Main Results:

• Children require lower local anesthetic concentrations, experience faster onset, but shorter duration of action.
• Peripheral blocks offer site-specific analgesia, with some having prolonged effects.
• Ultrasound guidance is recommended for abdominal wall blocks; caudal anesthesia is a key technique, with ropivacaine or levobupivacaine at specific concentrations being adequate.

Conclusions:

• Individual dose calculation is essential for pediatric local anesthesia.
• Ultrasound enhances safety and efficacy for certain blocks, though not always essential (e.g., caudal blocks).
• The use of pediatric epidural catheters may decrease due to potential complications, favoring other regional techniques.