Advances in Anaesthesia Techniques for Children

Abstract

Anaesthesiology is an ever-changing field. New drugs and techniques are continuously developed and considered for the anaesthetic plan, in a continuum of perioperative clinical practice, whether outpatient or inpatient. The use of regional anaesthesia techniques in children has increased dramatically. Local anaesthetics, once not considered by most anaesthetists for children anaesthesia, have become a valuable weapon even for the pediatric anaesthesiologist. Regional analgesia is most commonly used in conjunction with light general anaesthesia or sedation in pediatrics, although in certain circumstances a regional anaesthetic alone may be the preferred technique [1]. Combined general and regional anaesthesia is currently the most frequent routine technique used for children in many countries. Supplementing a general inhalation or intravenous anaesthetic with a central or peripheral nerve block results in pain-free awakening and excellent postoperative analgesia without the side effects of opioid drugs. The nervous blockade can be performed either before surgery or at the end of surgery, before the awakening. Performing the blockade at the end of surgery may prolong postoperative analgesia. As the block is performed after the induction of anaesthesia, but before the beginning of surgery, the use of intravenous or inhalation drugs is required for the maintenance of the anaesthetic. Consequently, the awakening results pain-free, quick, and smooth. Rarely, if ever, an anaesthetic should be performed without using some kind of local or regional analgesia. Indeed, even if a regional block is not feasible or desirable, it is possible to take advantage of the EMLA cream for intravenous cannulation or of the wound infiltration for postoperative analgesia. Paracetamol or even better the association of paracetamol and codeine is effective for pain control for minor and moderate surgery. These analgesics should be administered prior to surgery or, if a local or regional technique has been added, at the end of surgery by the rectal route for pre-emptive analgesia. Wound infiltration is definitely safe, easy, and very useful for early postoperative analgesia. This simple technique, which is greatly underused and undervalued, has virtually no contraindication, except a known documented previous undesired reaction to local anaesthetic agents. It allows the anaesthesiologist to gain time in order to plan and realize the postoperative pain treatment. For the anaesthetist, who is not familiar with regional analgesia techniques, wound infiltration is the best way to increase the quality of postoperative analgesia with no risks unless toxic doses of the local anaesthetic agent are injected.