Regional anaesthesia in neonates

  • M. Astuto
  • D. Sapienza
  • G. Rizzo
Conference paper


The last decade has seen many advances in the management of pain in neonates, which are based upon an increased understanding of the neurophysiology of pain, combined with the development of clinical pain services, analgesic delivery devices and monitoring protocols.


Spinal Anaesthesia Nerve Block Regional Anaesthesia Inguinal Hernia Repair Postoperative Analgesia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Peters JWB, Schouw R, Anand KJS et al (2005) Does neonatal surgery lead to increased pain sensitivity in later childhood? Pain 114:444–454PubMedCrossRefGoogle Scholar
  2. 2.
    Van Schoor AN, Boon JM, Bosenberg AT (2005) Anatomical considerations of the pediatric ilioinguinal/iliohypogastric nerve block. Paediatr Anaesth 15:371–377PubMedCrossRefGoogle Scholar
  3. 3.
    Willschke H, Marhofer P, Bosenberg A et al (2005) Ultrasonography for ilioinguinal/iliohypogastric nerve blocks in children. Br J Anaesth 95(2):226–230PubMedCrossRefGoogle Scholar
  4. 4.
    Ivani G, Mossetti V (2005) Continuous peripheral nerve blocks. Paediatr Anaesth 15: 87–90PubMedCrossRefGoogle Scholar
  5. 5.
    Gunter JB (2002) Benefit and risks of local anesthetics in infants and children. Pediatr Drugs 4:649–672Google Scholar
  6. 6.
    Dadure C, Capdevila X (2005) Continuous peripheral nerve blocks in children. Best Pract Res Clin Anaesthesiol 19:309–321PubMedCrossRefGoogle Scholar
  7. 7.
    Sciard D, Matuszczak M, Gebhard R (2001) Continuous posterior lumbar plexus block for acute postoperative pain control in infants. Anesthesiology 95:1521–1523PubMedCrossRefGoogle Scholar
  8. 8.
    Ivani G, Conio A, De Negri P et al (2002) Spinal versus peripheral effects of adjunct clonidine: comparison of the analgesic effect of a ropivacaine-clonidine mixture when administered as a caudal or ilioinguinal-iliohypogastric nerve blockage for inguinal surgery in children. Paediatr Anaesth 12:680–684PubMedCrossRefGoogle Scholar
  9. 9.
    Kaabachi O, Zerelli Z, Methamem M (2005) Clonidine administered as adjuvant for bupivacaine in ilioinguinal-iliohypogastric nerve block does not prolong postoperative analgesia. Paediatr Anaesth 15:586–590PubMedCrossRefGoogle Scholar
  10. 10.
    Lloyd-Thomas AR (1999) Modern concepts of paediatric analgesia. Pharmacol Ther 83:1–20PubMedCrossRefGoogle Scholar
  11. 11.
    Chawathe MS, Jones RM, Gildersleve CD et al (2003) Detection of epidural catheters with ultrasound in children. Paediatr Anaesth 13:681–684PubMedCrossRefGoogle Scholar
  12. 12.
    Roberts SA, Guruswamy V, Galvez I (2005) Caudal injectate can be reliably imaged using portable ultrasound — a preliminary study. Paediatr Anaesth 15:948–952PubMedCrossRefGoogle Scholar
  13. 13.
    Bosenberg A (1998) Epidural analgesia for major neonatal surgery. Paediatr Anaesth 8:479–483PubMedCrossRefGoogle Scholar
  14. 14.
    Larsson BA, Lonnqvist PA, Olsson GL (1997) Plasma concentrations of bupivacaine in neonates after continuous epidural infusion. Anesth Analg 84:501–505PubMedCrossRefGoogle Scholar
  15. 15.
    McClellan KJ, Faulds D (2000) Ropivacaine: an update of its use in regional anaesthesia. Drugs 60:1065–1093PubMedCrossRefGoogle Scholar
  16. 16.
    Rapp HJ, Molnar V, Austin S et al (2004) Ropivacaine in neonates and infants—a population pharmacokinetic evaluation following single caudal block. Paediatr Anaesth 14:724–732PubMedCrossRefGoogle Scholar
  17. 17.
    Bosenberg AT, Thomas J, Cronje L et al (2005) Pharmacokinetics and efficacy of ropivacaine for continuous epidural infusion in neonates and infants. Paediatr Anaesth 15:739–749PubMedCrossRefGoogle Scholar
  18. 18.
    Chalkiadis GA, Anderson BJ, Tay M et al (2005) Pharmacokinetics of levobupivacaine after caudal epidural administration in infants less than 3 months of age. Br J Anaesth 95:524–529PubMedCrossRefGoogle Scholar
  19. 19.
    Fellmann C, Gerber AC, Weiss M (2002) Apnoea in a former preterm infant after caudal bupivacaine with clonidine for inguinal herniorrhaphy. Paediatr Anaesth 12:637–640PubMedCrossRefGoogle Scholar
  20. 20.
    Hager H, Marhofer P, Sitzwohl C et al (2002) Caudal clonidine prolongs analgesia from caudal S(+)-ketamine in children. Anesth Analg 94:1169–1172PubMedCrossRefGoogle Scholar
  21. 21.
    Ooi R, Pattison J, Feldman SA (1991) The effects of intravenous clonidine on ventilation. Anaesthesia 46:632–633PubMedCrossRefGoogle Scholar
  22. 22.
    O’Halloran KD, Herman JK, Bisgard GE (2000) Ventilatory effects of alpha2-adrenoceptor blockade in awake goats. Respir Physiol 126:29–41CrossRefGoogle Scholar
  23. 23.
    De Negri P, Ivani G, Visconti C (2001) How to prolong postoperative analgesia after caudal anaesthesia with ropivacaine in children: S-ketamine versus clonidine. Paediatr Anaesth 11:679–683PubMedCrossRefGoogle Scholar
  24. 24.
    Bosenberg A (2004) Pediatric regional anesthesia update. Paediatr Anaesth 14:398–402PubMedCrossRefGoogle Scholar
  25. 25.
    Sartorelli KH, Abajian JC, Kreutz JM et al (1992) Improved outcome utilizing spinal anesthesia in high-risk infants. J Pediatr Surg 27:1022–1025PubMedCrossRefGoogle Scholar
  26. 26.
    Astuto M, Sapienza D, Disma N (2006) Spinal anaesthesia for inguinal hernia repair in an infant with Williams Syndrome: case report. Paediatr Anaesth (in press)Google Scholar
  27. 27.
    Saint-Maurice C (1995) Spinal anesthesia. In: Dalens B (ed) Regional anesthesia in infants, children and adolescents, 1st edn. Williams & Wilkins, Baltimore, pp 261–273Google Scholar
  28. 28.
    Finkel JC, Boltz MG, Conran AM (2003) Haemodynamic changes during high spinal anaesthesia in children having open heart surgery. Paediatr Anaesth 13:48–52PubMedCrossRefGoogle Scholar
  29. 29.
    Oberlander TF, Berde CB, Lam KH et al (1995) Infants tolerate spinal anesthesia with minimal overall autonomic changes: analysis of heart rate variability in former premature infants undergoing hernia repair. Anesth Analg 80:2027CrossRefGoogle Scholar
  30. 30.
    Katznelson R, Mishaly D, Hegesh T et al (2005) Spinal anesthesia for diagnostic cardiac catheterization in high-risk infants. Paediatr Anaesth 15:50–53PubMedCrossRefGoogle Scholar
  31. 31.
    Dohi S, Naito H, Takahashi T (1979) Age-related changes in blood pressure and duration of motor block in spinal anaesthesia. Anesthesiology 50:319–323PubMedCrossRefGoogle Scholar
  32. 32.
    Finkel JC, Boltz MG, Conran AM (2003) Haemodynamic changes during high spinal anaesthesia in children having open heart surgery. Paediatr Anaesth 13:48–52PubMedCrossRefGoogle Scholar
  33. 33.
    Tobias JD (2000) Spinal anaesthesia in infants and children. Paediatr Anaesth 10:5–16PubMedCrossRefGoogle Scholar
  34. 34.
    Shenkman Z, Hoppenstein D, Litmanowitz I et al (2002) Spinal anesthesia in 62 premature, former-premature or young infants-technical aspects and pitfalls. Can J Anaesth 49:262–269PubMedCrossRefGoogle Scholar
  35. 35.
    Mahe V, Ecoffey C (1988) Spinal anesthesia with isobaric bupivacaine in infants. Anesthesiology 68:601–603PubMedCrossRefGoogle Scholar
  36. 36.
    Kokki H, Touvinen K, Hendolin H (1998) Spinal anaesthesia for paediatric day-case surgery: a double-blind, randomized, parallel group, prospective comparison of isobaric and hyperbaric bupivacaine. Br J Anaesth 81:502–506PubMedGoogle Scholar
  37. 37.
    Frawley G, Farrell T, Smith S (2004) Levobupivacaine spinal anesthesia in neonates: a dose range finding study. Paediatr Anaesth 14:838PubMedCrossRefGoogle Scholar
  38. 38.
    Lederhaas G (2003) Spinal anaesthesia in paediatrics. Best Pract Res Clin Anaesthesiol 17(3):365–376PubMedCrossRefGoogle Scholar
  39. 39.
    Craven PD, Badawi N, Henderson-Smart DJ et al (2003) Regional (spinal, epidural, caudal) versus general anaesthesia in preterm infants undergoing inguinal herniorrhaphy in early infancy (review). The Cochrane Database of Systematic Reviews, Issue 3: Art. No.: CD003669Google Scholar
  40. 40.
    Rochette A, Troncin R, Raux O (2005) Clonidine added to bupivacaine in neonatal spinal anesthesia: a prospective comparison in 124 preterm and term infants. Paediatr Anaesth 15:1072–1077PubMedGoogle Scholar
  41. 41.
    Abajian JC, Mellish RWP, Brown AF et al (1984) Spinal anesthesia for surgery in the high-risk infant. Anesth Analg 63:359–362PubMedCrossRefGoogle Scholar
  42. 42.
    Sartorelli KH, Abajian JC, Kreutz JM et al (1992) Improved outcome utilizing spinal anesthesia in high-risk infants. J Pediatr Surg 27:1022–1025PubMedCrossRefGoogle Scholar
  43. 43.
    Blaise GA, Roy WL (1986) Spinal anaesthesia for minor paediatric surgery. Can Anaesth Soc J 33:227–230PubMedGoogle Scholar
  44. 44.
    Tobias JD, Flannagan J, Brock J et al (1993) Neonatal regional anesthesia: alternative to general anesthesia for urologic surgery. Urology 41:362–365PubMedCrossRefGoogle Scholar
  45. 45.
    Tobias JD, Flannagan J (1992) Regional anesthesia in the preterm neonate. Clin Pediatr 31:668–671CrossRefGoogle Scholar
  46. 46.
    Kokki H, Hendolin H, Vainio J et al (1992) Operationen im Vorschulalter: Vergleich von Spinalanasthesie und Allgemeinanasthesie. Anaesthetist 41:765–768Google Scholar
  47. 47.
    Kokki H, Hendolin H (1995) Comparison of spinal anaesthesia with epidural anaesthesia in paediatric surgery. Acta Anaesthesiol Scand 39:896–900PubMedGoogle Scholar
  48. 48.
    Melman E, Penuelas J, Marrufo J (1975) Regional anesthesia in children. Anesth Analg 54:387–390PubMedCrossRefGoogle Scholar
  49. 49.
    Parkinson SK, Little WL, Malley RA et al (1990) Use of hyperbaric bupivacaine with epinephrine for spinal anesthesia in infants. Reg Anesth 15:86–88PubMedGoogle Scholar
  50. 50.
    Rice LJ, DeMars PD, Whalen TV et al (1994) Duration of spinal anesthesia in infants less than one year of age. Reg Anesth 19:325–329PubMedGoogle Scholar
  51. 51.
    Aronsson DD, Gemery JM, Abajian JC (1996) Spinal anesthesia for spine and lower extremity surgery in infants. J Pediatr Orthop 16:259–263PubMedGoogle Scholar
  52. 52.
    Tobias JD, Mencio GA (1998) Regional anesthesia for clubfoot repair in children. Am J Therapeutics 5:273–277CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2007

Authors and Affiliations

  • M. Astuto
    • 1
  • D. Sapienza
    • 2
  • G. Rizzo
    • 2
  1. 1.Department of Anaesthesia and Intensive Care, Postgraduate School of Anaesthesia and Intensive CareCatania University HospitalCataniaItaly
  2. 2.Department of Anaesthesia and Intensive CareCatania University HospitalCataniaItaly

Personalised recommendations