3. 1.Safety of pediatric regional anesthesia
2.Pediatric regional anesthesia for upper extremity
3.Pediatric regional anesthesia for lower extremity
Contents
4. Benefit of Regional Anesthesia
Pediatric Anesthesia 22 (2012) 10–1
PAIN Control with
Regional Analgesia
Opioids
Nausea, Vomiting, Respiratory depression, GI motility
Surgical
Stress
response
Stress
hormones
release
Surgical
blood loss
BJA 113 (3): 375–90 (2014
MAC
Avoid
GA
Support
Care
Pain
Behavior
Rapid
Recovery
Double the anesthetic, Double the risk?
5. PRAN
Pediatric Regional Anesthesia Network
20 children hospitals
Dr. Santhanam Suresh
Department of Anesthesiology and director of the Pain Management Team
at Ann & Robert H. Lurie Children’s Hospital of Chicago
6. • From 2007 to 2015
• No permanent neurologic deficits
• Transient neurologic deficit
• 2.4:10,000
• Not different between peripheral and neuraxial blocks.
• Local anesthetic systemic toxicity
• 0.76:10,000
• Majority of cases occurred in infants.
Safety
Anesthesiology 2018; 129:721-32
13. • April 2007 through May 2013
• 518 ISB
• No LAST, PONSs
• 1 reported vascular puncture (? US)
• US use in 88%
Reg Anesth Pain Med 2014;39: 502–505
14. Not to routinely perform regional anesthetic or interventional pain medicine
procedures in anesthetized or deeply sedated adult patients
Peripheral and neuraxial nerve blocks in anesthetized children
seems not to increase injury
15. • 47 institution
• 31,132 regional blocks (1262 pure RA)
• Peripheral 66%, 29% upper and lower
• Overall rate of complication: 0.12 %
• 6 times higher in central vs peripheral blocks
• 4 times higher in < 6 months vs > 6 months
• Neurological symptoms of 0.17% in 29,870 blocks performed under GA.
• LAST occurred in only one awake patient
Safety
Paediatr Anaesth . 2010 Dec;20(12):1061-9.
16. • Zero mortality
• No permanent sequelae
RA under GA is
standard of care with good safety
19. • 10 yr, Female
• Distal Tibia Fx.
• Anaphylactic shock Hx.
• Propofol & Rocuronium
• Skin provocation test
• NMBA (+) Rocuronium (+)
• Refuse GA
• Popliteal sciatic nerve block and Saphenous nerve block
Avoid GA
20. Reg Anesth Pain Med 2016;41: 229–241
• Performance time: LM > US > NS
• Onset of block: reduced
• Block success: US (≈ LM) > NS
• Block quality:
• Analgesia consumption: Improved, (≈ NS)
• Duration: Improved
• Pain: Improved (≈ NS)
• LA spreading
• LA dose: ?
• Visualization of anatomical structures, needle/catheter
21. US vs No-US
• 33 trials
• 2293 participants
• 0.9 to 12 yr
• Reduces the failed block
• Pain reduction 1.3 points
• Block duration increase 42 min
• Procedure time
• Number of Needle pass
• No difference major complications
Cochrane Database of Systematic Reviews 2019, Issu
24. British Journal of Anaesthesia, 120 (2): 317-322 (201
• 40,121 block
• LA dose varied up to 10-fold for the same neve blocks
• Femoral 0.98 (0.36-2.19)
• Popliteal S 1.06 (0.42-1.94)
• SupraBPB 1.0(0.35-2.22)
• LAST 2 case
• No long term sequelae
• We Need Guideline !!!!!
LA Dose
31. Sequential ultrasound imaging technique
Songthamwat B, et al. Reg Anesth Pain Med 2021
7 yr, F
SUIT: identify the individual
elements of the brachial plexus
above the clavicle
45. Bendtsen TF, et al. Reg Anesth Pain Med 2021
Fascia iliaca compartment block
Kantakam P, et al. Reg Anesth Pain Med 2021
MEV90 for ultrasound-guided SIFIB was
estimated to be 62.5 mL (95% CI 60 to 65). Artificial passageways