Peripheral nerve blocks in pediatric anesthesia

Introduction Most children undergoing surgery can benefit from regional anesthetic techniques, either as the sole anesthetic regimen or, as usual in pediatric practice, in combination with general anesthesia. The use of peripheral nerve blocks (PNBs) in pediatric anesthesia is an effective way to decrease the side-effects and complications associated with central blocks. In spite of their many advantages, including easy performance end efficacy, peripheral nerve blocks are still underused. Objective This article discusses a general approach to PNBs in children and provides data concerning the practice of this regional technique in different age groups. Methods Data from 1,650 procedures were prospectively collected during the period from March 1, 2007 to February 29, 2008. The type of PNB, if any, as well as the patient age were noted. Our patients were divided into four groups: 0-3 years, 4-7 years, 8-12 years and 13-18 years. Results During the investigated period, PNBs as a sole technique or in anesthetized children were performed in 7.45% of cases. Ilioingunal/iliohypogastric nerve block and penile block were the most common (70% of all PNBs) distributed mainly among the children between 4-7 years of age (p<0.05). In older children, extremity PNBs predominate in regard to other types of blocks. PNBs are most frequently performed under general anesthesia (85%), so the perineural approach requires a safe technique to avoid nerve damage. Conclusion The observed differences in PNB usage seem to be related to patient age and correlate with common pathology and also with technical availability of PNB performance.

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Comparative outcomes of peripheral nerve blocks versus general anesthesia for hip fractures in geriatric Chinese patients

Patient Preference and Adherence ◽

10.2147/ppa.s61903 ◽

2014 ◽

pp. 651

Author(s):

Hong Zhang ◽

Gong MaoWei ◽

Wang XiaoLin ◽

Mai HaiXing ◽

Shujun Pei ◽

...

Keyword(s):

Peripheral Nerve ◽

General Anesthesia ◽

Hip Fractures ◽

Chinese Patients ◽

Nerve Blocks ◽

Peripheral Nerve Blocks

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The Relationship Between Current Intensity for Nerve Stimulation and Success of Peripheral Nerve Blocks Performed in Pediatric Patients Under General Anesthesia

Survey of Anesthesiology ◽

10.1097/sa.0b013e31817c5b7e ◽

2008 ◽

Vol 52 (4) ◽

pp. 177

Author(s):

&NA;

Keyword(s):

Peripheral Nerve ◽

General Anesthesia ◽

Nerve Stimulation ◽

Pediatric Patients ◽

Current Intensity ◽

Nerve Blocks ◽

Peripheral Nerve Blocks ◽

The Relationship

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Efficiency of ultrasound guided lower limb peripheral nerve blocks in perioperative pain management for knee arthroscopy in children: A randomized study

Medicinski pregled ◽

10.2298/mpns1602005m ◽

2016 ◽

Vol 69 (1-2) ◽

pp. 5-10

Author(s):

Dragan Marinkovic ◽

Jovana Simin ◽

Biljana Draskovic ◽

Ivana Kvrgic ◽

Marina Pandurov

Keyword(s):

Postoperative Pain ◽

Peripheral Nerve ◽

General Anesthesia ◽

Lower Limb ◽

Knee Arthroscopy ◽

Opioid Analgesics ◽

Ultrasound Guided ◽

Nerve Blocks ◽

Peripheral Nerve Blocks ◽

Group B

Introduction. Ultrasound guided lower limb peripheral nerve blocks are efficient for perioperative pain treatment in children. The aim was to see if lower limb peripheral nerve blocks reduced the amount of propofol and opioid analgesics used intraoperatively, as well as the level of pain and consumption of systemic analgesics postoperatively. Material and Methods. A randomized, prospective clinical trial was carried out. It included 60 children between 11 and 18 years of age scheduled for elective knee arthroscopy. The patients were divided into two groups. Group A received general anesthesia, group B received lower limb peripheral nerve blocks with sedation or general anesthesia. Postoperative level of pain was assessed using visual analogue scale. Results. Less propofol and fentanyl was used to induce and maintain anesthesia in group B (p<0.001). The level of postoperative pain was significantly lower in group B (p<0.001), as well as the postoperative consumption of analgesics (p<0.001). As mahbny as 47% of the patients were discharged without receiving any analgesics postoperatively. The average duration of peripheral nerve blocks was 468 minutes. Conclusions. Ultrasound guided lower limb peripheral nerve blocks are an efficient technique of regional anesthesia in children. They reduce the amount of general anesthetics and opioid analgesics needed intraoperatively as well as the level of postoperative pain and consumption of analgesics postoperatively.

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Variation in pediatric local anesthetic dosing for peripheral nerve blocks: an analysis from the Pediatric Regional Anesthesia Network (PRAN)

Regional Anesthesia and Pain Medicine ◽

10.1136/rapm-2020-101720 ◽

2020 ◽

Vol 45 (12) ◽

pp. 964-969 ◽

Cited By ~ 2

Author(s):

Andreas H Taenzer ◽

Michael Herrick ◽

Matthew Hoyt ◽

R J Ramamurthi ◽

Benjamin Walker ◽

...

Keyword(s):

Peripheral Nerve ◽

Regional Anesthesia ◽

Local Anesthetic ◽

Age Groups ◽

Geographic Location ◽

Average Weight ◽

Nerve Blocks ◽

Peripheral Nerve Blocks ◽

Increased Risk ◽

The Mean

BackgroundVariation of local anesthetic dosing has been reported for adult peripheral nerve blocks (PNBs) and infant caudal blocks. As higher doses of local anesthetics (LA) are potentially associated with increased risk of complications (eg, local anesthetic systemic toxicity), it is important to understand the source of LA dose variation. Using the Pediatric Regional Anesthesia Network (PRAN) database, we aimed to determine if variation in dosing exists in pediatric single-injection PNBs, and what factors influence that variation.The primary aim of this study was to determine the factors associated with dosing for the 10 most commonly performed PNBs, with the secondary aim of exploring possible factors for variation such as number of blocks performed versus geographic location.MethodsThe PRAN database was used to determine the 10 most common pediatric PNBs, excluding neuraxial regional anesthetics. The 10 most common pediatric PNBs in the PRAN database were analyzed for variation of LA dose and causes for variation.ResultsIn a cohort of 34 514 children receiving PNBs, the mean age was 10.38 (+/-5.23) years, average weight was 44.88 (+/-26.66) kg and 61.8% were men. The mean bupivacaine equivalent (BE) dose was 0.86 (+/-0.5) mg kg−1 and ropivacaine was used in 65.4% of blocks. Dose decreases with age (estimate −0.016 (−0.017, –0.015; p<0.001)). In all blocks for all age groups, the range of doses that make up the central 80% of all doses exceeds the mean BE dose for the block. Variation is not related to the number blocks performed at an institution (p=0.33 (CI −0.42 to 0.15)). The dose administered for a PNB is driven in order of impact by the institution where the block was performed (Cohen’s ƒ=0.45), then by weight (0.31), type of block (0.27), LA used (0.15) and age (0.03).ConclusionsConsiderable variation in dosing exists in all age groups and in all block types. The most impactful driver of local anesthetic dose is the institution where the block was performed, indicating the dosing of a potentially lethal drug is more based on local culture than on evidence.

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