Regional Anaesthesia In Paediatric Patient:

Wesam Marzok Fouda

Regional anaesthesia, alone or combined with I ~t generalanaesthesia, has many advantages in paediatric surgery. lt providesexcellent operative conditions, as well as being an excellen method forpostoperative pain relief.The anaesthesiologists must understand the anatomica differencesbetween the child and the adult patients as regards the anatomicallandmarks, size and depth of different structures. The pre :eduresalsorequires an understanding of the physiological differences v iich modifythe child’s response to the different block techniques, part cularlywithconduction block along the neuraxis. The pharmacokine ics and thedosages of local anaesthetics are also different from that of a, lit patients.The different techniques of regional anaesthesia used enadults areacceptable in paediatrics,’ provided that the anaesthesk ogists haveextensive experiences with the techniques to reduces the COIf ilications.Caudal anaesthesia is the most frequently em: toyed localanaesthetic technique in paediatric surgery. It has been us’ d for severalyears in many paediatric centers for circumcision, orchiope y and herniarepair.Lumbar and thoracic epidural blocks have many adv atages. Theyallow accessibility to all spinal segments. Therefore, ur logic, upperabdominal and chest surgeries can be performed. The , also allowrepeated administration of local anaesthetics and narcotic analgesics inthe postoperative period through an indwelling catheter.Spinal anaesthesia has been used for any surgical proce ares belowthe diaphragm, especially in high risk infants. Therefore it is nowrecommended by several authors to be the anaesthetic 0 choice inpremature infants who are more liable to life threatening apm l. and othercomplications after general anaesthesia.All peripheral nerve blocks used in adults can be 1=rformed inchildren as well. A peripheral nerve stimulator can be used to dentify theperipheral nerves, thereby, avoiding the uncooperation of :he child tomonitor paresthesia.Brachial plexus block by the axillary approach ; the mostsatisfactory block for the upper limb operations in children It providesexcellent muscle relaxation and complete intra- and postoj :rative painrelief.• Femoral nerve block is a useful method for pain relie in childrenwith femoral shaft fractures, since it will relieve muscle spt un, provideimmediate analgesia, and allow time for the patient to be .repared forsurgery. •Sciatic nerve block has been used primarily for orthopaedicsurgery, but it can also be useful to provide analgesia for ( iildren withtibial fractures.Penile block which is becoming increasingly popul r, is a safe;.simple and easy technique to provide post-circumcision anal! .sia.The interest in topical anaesthesia has been renewed j l paediatricsby the availability of several new ointments such asEMLA cream,TACcream, and lidocaine -adrenaline-tetracaine gel.Regional anaesthesia can benefit children by imp oving theoperative conditions and providing postoperative analgesia. H4 wever,theanaesthesiologists must have a clear understanding of the 3.1 atomy, theinfluence of age and size, and the potential complications.