Regional Anesthesia for Infants and Children
Regional anesthesia in children differs in many respects from adults. Most pediatric regional blocks are placed after induction of anesthesia to provide post-operative analgesia. Complications associated with this approach are very low as shown by several large prospective surveys. Local anesthetic spread is generally more reliable than in adults, but higher volumes in relation to body weight are usually required for neuraxial single shot blocks and infusions. Single shot blocks and wound infiltration are commonly used to minimize opiate use in day case surgery and to reduce the distress frequently seen when small children emerge from anesthesia with inadequate analgesia. The pharmacokinetics of local anesthetic agents are different in neonates and young children compared with adults. There is a high risk of toxicity in neonates and infants because of reduced protein binding and metabolism. Local anesthetic additives are not as well studied and less frequently used in children compared with adults. Clonidine however, is frequently added during caudal block to prolong duration and provide sedation. Sedation is sometimes an important addition to regional techniques, because good analgesia alone does not guarantee lack of distress, particularly in pre-school children who may be distressed by their environment, restriction of movement or effects of surgery or equipment.
KeywordsLocal anesthetic pharmacology in children Pediatric epidural Caudal block Sacral hiatus Dorsal nerve block
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