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Regional analgesia on pediatric medical and surgical wards
C B Berde1, N F Sethna, L Levin
1Department of Anesthesia, Children's Hospital, Boston, Massachusetts.
Insights
Regional anesthesia offers effective pain management for pediatric patients on hospital wards. With careful protocols, these techniques provide significant benefits, though minor side effects are common.
Area of Science:
- Pediatric Anesthesiology
- Pain Management
- Regional Anesthesia
Background:
- Effective pain management in pediatric patients is crucial for recovery and well-being.
- Traditional analgesia methods may have limitations in providing adequate pain relief for certain procedures.
- Implementing advanced techniques like regional anesthesia on hospital wards requires specific safety protocols.
Purpose of the Study:
- To evaluate the safety and efficacy of regional anesthetic approaches for pain management in children and young adults outside of intensive care settings.
- To establish a protocol for the safe administration of regional anesthesia on surgical and medical wards.
- To identify potential complications and side effects associated with these techniques in a pediatric population.
Main Methods:
- A protocol was developed for conducting regional anesthesia on hospital wards for 72 pediatric patients (3 weeks to 31 years).
- Resuscitation equipment was readily available, and specific monitoring (apnea, respiratory rate) was employed for patients receiving epidural narcotics.
- Anesthesiologist-administered bolus re-injections and 20-minute patient monitoring were standard procedures.
Main Results:
- Minor, manageable side effects such as pruritus, nausea, and urinary retention were frequently observed.
- Significant complications were rare, including decubitus ulcers, mild hypotension in a terminally ill patient, and a mild toxic reaction.
- Regional analgesic techniques demonstrated the potential for excellent pain relief on hospital wards for selected pediatric patients.
Conclusions:
- Regional anesthetic techniques can be safely and effectively utilized for pain management in pediatric patients on hospital wards when appropriate precautions are implemented.
- While minor side effects are common, significant complications are infrequent, suggesting a favorable risk-benefit profile for selected cases.
- Further research is needed to delineate specific indications, risks, and benefits compared to simpler analgesic methods in pediatric populations.
Abstract:
Regional anesthetic approaches to pain management were examined in 72 children and young adults (ages 3 weeks to 31 years) who were observed on the surgical or medical wards of a children's hospital separate from intensive care areas. A protocol was devised to permit safe conduct of these techniques on the ward. Full resuscitation supplies were kept at each bedside. All patients receiving epidural narcotics had an apnea monitor, hourly counting of respiratory rates, and restriction of systemic analgesics. All bolus re-injections into the catheters were performed by an anesthesiologist who monitored the patient for 20 min. Minor side-effects, including pruritus, nausea, and urinary retention were common, but manageable. Significant complications included: one case of decubitus ulcers requiring skin-grafting, one episode of mild hypotension in a patient with terminal malignancy, requiring ephedrine and phenylephrine, and one mild toxic reaction on test dosing due to presumed intravascular migration of a lumber sympathetic catheter. Regional analgesic techniques can provide excellent analgesia on the wards for selected children and young adults, provided precautions are taken. Further study is required to define specific indications, risks and benefits relative to simpler techniques.