欧洲区域麻醉与疼痛治疗学会和美国区域麻醉与疼痛医学学会联合委员会关于小儿区域麻醉争议话题的实践咨询意见

The European Society of Regional Anaesthesia and Pain Therapy and the American Society of Regional Anesthesia and Pain Medicine Joint Committee Practice Advisory on Controversial Topics in Pediatric Regional Anesthesia.

作者信息

Ivani Giorgio, Suresh Santhanam, Ecoffey Claude, Bosenberg Adrian, Lonnqvist Per-Anne, Krane Elliot, Veyckemans Francis, Polaner David M, Van de Velde Marc, Neal Joseph M

机构信息

From the *Department of Anesthesiology, Regina Margherita Children's Hospital, Turin, Italy; †Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, IL; ‡Pôle Anesthésie-SAMU-Urgences-Réanimations, Hôpital Pontchaillou, Université Rennes 1, Rennes, France; §University of Washington and Seattle Children's Hospital, Seattle, WA; ∥Section of Anaesthesiology and Intensive Care, Department of Physiology and Pharmacology, Karolinska Institutet; and Paediatric Anaesthesia/PICU/ECMO Services, Karolinska University Hospital, Stockholm, Sweden; **Departments of Pediatrics, and Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA; ††Cliniques Universitaires St Luc, Catholic University of Louvain Medical School, Brussels, Belgium; ‡‡Departments of Anesthesiology and Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO; §§Department of Cardiovascular Sciences, KULeuven; and Department of Anesthesiology, UZLeuven, Leuven, Belgium; and ∥∥Department of Anesthesiology, Virginia Mason Medical Center, Seattle, WA.

出版信息

Reg Anesth Pain Med. 2015 Sep-Oct;40(5):526-32. doi: 10.1097/AAP.0000000000000280.

DOI:10.1097/AAP.0000000000000280

PMID:26192549

Abstract

BACKGROUND AND OBJECTIVES

Some topics in the clinical management of regional anesthesia in children remain controversial. To evaluate and come to a consensus regarding some of these topics, The European Society of Regional Anaesthesia and Pain Therapy (ESRA) and the American Society of Regional Anesthesia and Pain Medicine (ASRA) developed a joint committee practice advisory on pediatric regional anesthesia (PRA).

METHODS

Representatives from both ASRA and ESRA comprised the joint committee practice advisory on PRA. Evidence-based recommendations were based on a systematic search of the literature. In cases where no literature was available, expert opinion was elicited. Experts selected controversial topics in PRA.

RESULTS

The performance of PRA under general anesthesia or deep sedation is associated with acceptable safety and should be viewed as the standard of care (Evidence B2 and Evidence B3). Because of the difficulty interpreting a negative test dose, the use of test dosing should remain discretionary (Evidence B4). The use of either air-loss of resistance or saline-loss of resistance techniques is supported by expert opinion, but the literature supporting one technique over the other is sparse and controversial; when used appropriately, each technique may be safely used in children. There are no current evidence-based data that the use of RA increases the risk for acute compartment syndrome or delays its diagnosis in children.

CONCLUSIONS

High-level evidence is not yet available for the topics evaluated, and most recommendations are based on Evidence B studies. The ESRA/ASRA recommendations intend to provide guidance for the safe practice of regional anesthesia in children.

摘要

背景与目的

儿童区域麻醉临床管理中的一些话题仍存在争议。为了对其中一些话题进行评估并达成共识，欧洲区域麻醉与疼痛治疗学会（ESRA）和美国区域麻醉与疼痛医学学会（ASRA）成立了一个关于小儿区域麻醉（PRA）的联合委员会实践咨询小组。

方法

ASRA和ESRA的代表共同组成了PRA联合委员会实践咨询小组。基于循证的建议是通过对文献进行系统检索得出的。在没有相关文献的情况下，则征求专家意见。专家们选定了PRA中有争议的话题。

结果

在全身麻醉或深度镇静下实施PRA具有可接受的安全性，应被视为标准治疗方法（证据B2和证据B3）。由于对阴性试验剂量的解读存在困难，试验剂量的使用仍应酌情决定（证据B4）。专家意见支持使用空气阻力消失法或生理盐水阻力消失法，但支持一种方法优于另一种方法的文献较少且存在争议；如果使用得当，每种方法都可安全地用于儿童。目前尚无循证数据表明在儿童中使用区域麻醉会增加急性筋膜室综合征的风险或延迟其诊断。