Regional anaesthesia in children: an update

Abstract

Regional anaesthesia for children continues to grow in popularity. The potential benefits of regional anaesthesia over more conventional methods are well recognised, but the level of evidence is small since there are few well designed randomised controlled studies on infants or children. Practice patterns have changed over the past decade. Peripheral nerve blocks are increasingly more favoured than neuraxial blocks. This change has been fuelled by the lower reported incidence of complications associated with peripheral nerve blocks, and is also in keeping with the increase in laparoscopic and thoracoscopic surgery. There has been renewed interest in children following recently described transversus abdominis plane, maxillary nerve and lumbar plexus blocks. The analgesic effect of a “single-shot” block is limited to approximately five hours, irrespective of whether or not bupivacaine, ropivacaine or levobupivacaine are used. Peripheral nerve catheters and adjuvants are two options that are used to prolong the duration of analgesia. Clonidine and ketamine have essentially replaced opiates as the most popular adjuvant in many institutions. Technological advancements are likely to make regional anaesthesia both safer and easier to perform in the future.

Keywords: regional anaesthesia, paediatric, outcomes, maxillary nerve, lumbar plexus, TAP block, clonidine, ketamine