Ivani Giorgio, Mossetti Valeria
Department of Anesthesia and Intensive Care Unit, Regina Margherita Children's Hospital, Turin, Italy.
Paediatr Drugs. 2008;10(2):107-14. doi: 10.2165/00148581-200810020-00005.
Regional anesthesia is widely employed for postoperative pain control in both adults and children. Central or perineural approaches can be performed as a bolus injection or as a continuous infusion of local anesthetics. However, bolus injections, even with the addition of adjuvants, are inadequate for prolonged surgery and long-term pain control. Continuous infusion remains the technique of choice when there is a prolonged operation or intense postoperative pain. This article reviews the safety and efficacy of central and perineural continuous infusions for postoperative pain control in children. The literature confirms the very low rate of complications and adverse effects of regional anesthesia in children. However, clinicians need to be aware of the key points for performing a block and placing a catheter in children: good knowledge of anatomic and physiologic differences between adults and children is necessary; the use of newer local anesthetics, such as ropivacaine and levobupivacaine, increases the therapeutic window; and that it is mandatory to work with dedicated pediatric equipment. Through the use of new techniques such as nerve mapping and/or ultrasound the success of blocks can be improved and the risks reduced.
区域麻醉在成人和儿童术后疼痛控制中均被广泛应用。中枢或神经周围途径可通过单次推注或局部麻醉药持续输注来实施。然而，即使添加佐剂，单次推注也不足以应对长时间手术和长期疼痛控制。当手术时间延长或术后疼痛剧烈时，持续输注仍是首选技术。本文综述了中枢和神经周围持续输注用于儿童术后疼痛控制的安全性和有效性。文献证实儿童区域麻醉的并发症和不良反应发生率极低。然而，临床医生需要了解在儿童中实施阻滞和放置导管的关键点：必须熟知成人与儿童在解剖学和生理学上的差异；使用新型局部麻醉药，如罗哌卡因和左旋布比卡因，可增加治疗窗；并且必须使用专用的儿科设备。通过使用诸如神经定位和/或超声等新技术，可提高阻滞成功率并降低风险。
