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Continuous peripheral nerve blocks in paediatrics

  • G. Ivani
  • A. Sarti
  • V. Mossetti
Conference paper

Abstract

The control of long-term pain in children is a real problem for the paediatric anaesthesiologist. The ideal pain treatment would provide complete pain relief without interference with the daily life of the child, and the techniques and drugs would cause as few side effects as possible. For this reason, in recent years, there has been a renaissance in regional anaesthesia in children, in part because of a greater concern about postoperative pain management in young patients, and in part because of technical advances in equipment needed to perform the blocks. In fact, several techniques and routes can be used for pain treatment, but all have side effects. The intramuscular approach should be avoided in children not only from a psychological point of view (fear of needles, pain) but also because drug absorption is unpredictable. Intravenous opioid infusions are widely used, but their use for long-term pain control can lead to important side effects, such as nausea and vomiting, pruritus, urinary retention, gastrointestinal impairment and respiratory depression, so that doses must be titrated and managed; they must be limited to selected cases when no other options are available. An epidural infusion may be an alternative but can have such side effects as motor block, urinary retention and anaesthesia/analgesia also in the contralateral leg.

Keywords

Brachial Plexus Nerve Block Club Foot Femoral Nerve Block Peripheral Nerve Block 
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.

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References

  1. 1.
    Giaufrè E, Dalens B, Gombert A (1996) Epidemiology and morbidity of regional anaesthesia in children: a one-year prospective survey of the French-language society of pediatric anaesthesiologists. Anesth Analg 83: 904–912PubMedGoogle Scholar
  2. 2.
    Bosenberg A, Ivani G (1998) Regional anaesthesia: children are different (editorial). Paediatr Anaesth 8: 447–450PubMedCrossRefGoogle Scholar
  3. 3.
    Krane JE (2002) The ethics of regional anesthesia in anesthetized children. TRAPM 6: 90–94Google Scholar
  4. 4.
    Coté CJ, Karl HW, Notterman DA et al (2000) Adverse sedation events in pediatrics: analysis of medications used for sedation. Pediatrics 4: 633–644CrossRefGoogle Scholar
  5. 5.
    Ivani G, Codipietro L, Gagliardi F et al (2003) A long term infusion via a sciatic catheter in a 3-years-old-boy. Paediatr Anaesth (in press)Google Scholar
  6. 6.
    Singelyn FJE (2002) Continuous peripheral nerve blocks in infants and children. TRAPM 6: 108–114Google Scholar
  7. 7.
    Rosenblatt R (1980) Continuous femoral anesthesia for lower extremity surgery. Anesth Analg 59: 631–632PubMedGoogle Scholar
  8. 8.
    Fewtrell MS, Sapsford DJ, Herrick MJ et al (1994) Continuous axillary nerve block for chronic pain. Arch Dis Child 70: 54–55PubMedCrossRefGoogle Scholar
  9. 9.
    Johnson CM (1994) Continuous femoral nerve blockade for analgesia in children with femoral fractures. Anaesth Intensive Care 22: 281–283PubMedGoogle Scholar
  10. 10.
    Matuszczak M,Sciard D, Gebhard R et al (200 1) Upper extremity continuous perineural block in children. Anesthesiology 95:Al236Google Scholar
  11. 11.
    Pant O, Sallabery M, Schreiber-Deturmeny E et al (2001) Continuous fascia iliaca compartment block in children: a prospective evaluation of plasma bupivacaine concentrations, pain scores, and side effects. Anesth Analg 92: 1159–1163CrossRefGoogle Scholar
  12. 12.
    Sciard D, Matuszczak M, Gebhard R et al (2001) Continuous posterior lumbar plexus block for acute postoperative pain control in infants. Anesthesiology 95: 1521–3PubMedCrossRefGoogle Scholar
  13. 13.
    Berde CB (1993) Toxicity of local anesthetics in infants and children. J Pediatr 122: 14–20Google Scholar
  14. 14.
    Wood CE, Goresky GV, Klassen KA et al (1994) Complications of continuous epidural infusions for postoperative analgesia in children. Can J Anaesth 41: 613–20PubMedCrossRefGoogle Scholar
  15. 15.
    Ivani G (2002) Ropivacaine: is it time for children? Paediatr Anaesth 12: 383–387PubMedCrossRefGoogle Scholar
  16. 16.
    Ivani G, DeNegri P, Conio A (2002) Comparison of racemic bupivacaine, ropivacaine, and levo-bupivacaine for pediatric caudal anesthesia: effects on postoperative analgesia and motor block. Reg Anesth Pain Med 27: 157–161PubMedGoogle Scholar
  17. 17.
    Ivani G, De Negri P, Lonnqvist PA et al (2003) Comparison of three different concentrations of levobupivacaine for caudal block in children. Anesth Analg 97: 368–371PubMedCrossRefGoogle Scholar
  18. 18.
    Morton NS (2000). Ropivacaine in children. Br J Anaesth 85: 344–346PubMedCrossRefGoogle Scholar
  19. 19.
    Gunter J B (2002) Benefit and risks of local anesthetics in infants and children. Pediatr Drugs 4: 649–672Google Scholar
  20. 20.
    Tan T, Watcha M, Safavi F et al (1995) Cannulation of the axillary brachial plexus sheath in children. Anesth Analg 80: 640–641PubMedGoogle Scholar
  21. 21.
    Tobias J (1994) Continuous femoral nerve block to provide analgesia following femur fracture in a pediatric ICU population. Anaesth Intensive Care 22: 616–618PubMedGoogle Scholar
  22. 22.
    Bosenberg A, Raw R, Boezaart (2002) AP Surface mapping of peripheral nerves in children with a nerve stimulator. Paediatr Anaesth 12: 398–403Google Scholar
  23. 23.
    Benzon HT, Kim C, Benzon HP et al (1997) Correlation between evoked motor response of the sciatic nerve and sensory blockade. Anesthesiology 87: 547–552PubMedCrossRefGoogle Scholar
  24. 24.
    Audenaert S, Vickers H, Burgess S (1991) Axillary block for vascular insufficiency after repair of radial club hands in an infant. Anesthesiology 74: 368–370PubMedCrossRefGoogle Scholar

Suggested further reading

  1. Dalens B (1995) Regional anesthesia in infants, children and adolescents. William & Wilkins, BaltimoreGoogle Scholar

Copyright information

© Springer-Verlag Italia, Milano 2004

Authors and Affiliations

  • G. Ivani
  • A. Sarti
  • V. Mossetti

There are no affiliations available

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