Pediatric Anesthesia, Department of Anesthesia, Kantonsspital, Lucerne 16, Switzerland.
Curr Opin Anaesthesiol. 2013 Jun;26(3):327-32. doi: 10.1097/ACO.0b013e3283606a1e.
To discuss the developments in pediatric regional anesthesia which are currently under discussion and relevant to the practitioner.
The ongoing interest in regional anesthesia for pain relief is justified by its inclusion in current pain guidelines as well as by a good safety record in the recent epidemiological studies. Abdominal wall blocks, for example, transversus abdominis plane block, are emergent techniques and widely used; however, there are still unanswered questions, for example, the duration of analgesia. Caudal block still remains the single most important technique. According to the recent meta-analyses, the duration of analgesia can be prolonged by approximately 4 h by the addition of clonidine to the local anesthetics. On the other hand, there is some consensus emerging that ketamine should probably be abandoned as an additive to local anesthetics. Ultrasound is increasingly being used for a variety of regional anesthetics. For caudal blocks, it probably should be used mainly for teaching purposes or in cases of anatomical variants. The visible difference between the anatomical and the clinical spread revives the discussion on the exact site of action of an epidural block.
Pediatric regional anesthesia is still a developing field, both clinically and scientifically.
讨论目前正在讨论的与儿科从业者相关的小儿区域麻醉新进展。
区域麻醉在缓解疼痛方面的持续应用，是其被纳入当前疼痛指南以及在最近的流行病学研究中具有良好安全性记录的合理依据。例如，腹横筋膜平面阻滞等腹壁阻滞是新兴技术，应用广泛；但仍存在一些悬而未决的问题，例如镇痛持续时间。骶管阻滞仍然是最重要的单一技术。根据最近的荟萃分析，在局麻药中加入可乐定可使镇痛持续时间延长约 4 小时。另一方面，人们越来越达成共识，认为氯胺酮可能应被弃用作为局麻药的添加剂。超声越来越多地用于各种区域麻醉。对于骶管阻滞，它可能主要用于教学目的或在解剖变异的情况下使用。解剖和临床扩散之间的明显差异重新引发了关于硬膜外阻滞确切作用部位的讨论。
儿科区域麻醉在临床和科学方面仍在不断发展。
