Pediatric postop reg analg

Pediatrics

Blocks that are used most frequently are: Rectus sheath block (here the thoracic intercostal nerve is blocked which is responsible for sensation along the anterior abdominal wall – most often used for repair of an umbilical hernia). Illioinguinal nerve block (placed 1-2 cm medial and inferior to the ASIS and depositing local anesthetic into the fascia – used for hernia repairs or orchidopexy).  Femoral nerve block (for femur fractures or the need for quadriceps muscle biopsies).  Caudal block (employed for operations below the level of the diaphragm – placed by advancing a 22- or 23- gauge needle into the sacrococcygeal ligament between the two sacral cornua).    

As in the adult population, complications with pediatric regional techniques are uncommon.   A large prospective one-year survey of more than 24,000 pediatric regional anesthetics found an overall incidence of complications of 0.9 in 1000 blocks, with no complications of peripheral techniques.  The most common complications were either failure to establish a block or failure of block maintenance.  Failure of establishment of adequate neuraxial blockade in babies may be at least in part due to the significant variability of anesthetic spread.  Radiological assessment of contrast injected through epidural catheters in babies (1.8–4.5 kg) after major surgery found that both the quality and extent of spread were different for every baby.  Filling defects and ‘skipped’ segments were common.  Spread was more extensive after 1 ml/kg compared with 0.5 ml/kg — but not twice as great — with fewer ‘skipped’ segments and greater density of dye.

Sources

    Murray, MJ. Faust’s Anesthesiology Review 4th Ed. 466-467. 2014.

    Anesth Analg. 2012 Dec;115(6):1259-62

    [PubMed: 22696610]

    Br J Anaesth. 2005 Nov;95(5):725

    [PubMed: 15668207]

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2014

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