A Review of Regional Anesthesia in Infants

Area of Science:

• Pediatric Anesthesiology
• Pain Management
• Regional Anesthesia Techniques

Background:

• Regional anesthesia is increasingly utilized in infants for pain relief and anesthesia.
• It offers advantages over general anesthesia, including reduced opioid exposure and stress response.
• Ultrasound guidance has improved the safety and efficacy of peripheral nerve blocks in this population.

Purpose of the Study:

• To review the safety and efficacy of regional anesthesia in infants.
• To discuss pharmacokinetic and pharmacodynamic considerations of local anesthetics in neonates and infants.
• To highlight risk factors and management strategies for local anesthetic systemic toxicity (LAST) in infants.

Main Methods:

• Review of age-specific data on regional anesthesia in infants.
• Analysis of pharmacokinetic and pharmacodynamic profiles of local anesthetics.
• Examination of risk factors, incidence, and treatment of local anesthetic systemic toxicity.

Main Results:

• Regional anesthesia demonstrates safety and efficacy in infants, with benefits including decreased opioid exposure and improved hemodynamic stability.
• Peripheral nerve blocks are advancing due to ultrasound technology.
• Infants, particularly those under 6 months, are at higher risk for local anesthetic systemic toxicity, especially with bolus doses and penile nerve blocks. Bupivacaine accumulation with continuous infusion is noted, with 2-chloroprocaine as a potential alternative.

Conclusions:

• Regional anesthesia is a valuable tool for pediatric pain management, offering significant benefits over general anesthesia.
• Careful consideration of local anesthetic properties and administration techniques is essential to minimize toxicity risks in infants.
• Management of local anesthetic systemic toxicity requires prompt airway control, seizure suppression, resuscitation, and prompt administration of intravenous lipid emulsion.