الفهرس 
Safety of Regional Anesthesia in Pediatric PatientsOnly 14 pages are availabe for public view
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Abstract
Pediatric regional anesthesia has gone through significant development in recent years with advances in safety information, pharmacology, and block techniques. There is an increasing interest in regional anesthesia in pediatrics beyond the common caudal, epidural, or spinal. With improvements in equipment that are specific to children and the addition of ropivacaine as a proven local anesthetic, pediatric regional anesthesia, and specifically peripheral nerve blockade, should continue to gain popularity (Allison et al, 2008).
Epidural analgesia has many beneficial effects in the pediatric patient population. In clinical practice, it is commonly used to augment general anesthesia and to manage postoperative pain. Effective postoperative pain relief from epidural analgesia has numerous benefits including earlier ambulation, rapid weaning from ventilators, reduced time spent in a catabolic state and lowered circulating stress hormone levels. Precise placement of epidural needles and catheters for single-shot and continuous epidural anesthesia ensures that the dermatomes involved in the surgical procedure are selectively blocked, allowing for lower doses of local anesthetics and sparing of unnecessary blockade in the regions where blockade is not desired (Henderson et al, 2008).
Caudal epidural blockade is widely used to provide perioperative analgesia in pediatric practice. As a single injection, it offers a reliable and effective block for patients undergoing urological, general and orthopedic surgery involving the lower abdomen and lower limbs. A single-shot caudal epidural may not be suitable for every case as it has a limited dermatomal distribution and a short duration of action. New local anesthetics and adjuvants, as well as continuous catheter approaches may overcome these limitations (Krane et al, 1998).
Spinal anesthesia in pediatrics is most commonly used in the preterm infant undergoing anesthesia for hernia repair. Spinal anesthesia can also be used effectively in children for postoperative pain relief especially if opioids are used (Tobias, 2000).
The use of peripheral nerve blocks has been regaining significant popularity in the daily practice of most anesthesiologists. Despite the trend towards increase in the use of regional anesthesia and nerve blocks in adults, peripheral nerve blocks in children remain underutilized. Common reasons include the concern of neurologic complications and the lack of technical skills required for successful use of peripheral nerve blocks. The goal of these techniques that specifically and peripherally target the location of the surgery is to minimize the undesirable side effects of central regional blocks such as urinary retention, hypotension, and muscle weakness in unaffected areas as was demonstrated in a large-scale study by the French-Language Society of Pediatric Anesthesiologists. This led many anesthesiologists to suggest that peripheral blocks be used more often in place of central blocks when appropriate (Ivani and Tonetti, 2004).