Aksu Can, Yörükoğlu Hadi Ufuk, Cesur Sevim, Kuş Alparslan
Department of Anesthesiology and Reanimation, School of Medicine, Kocaeli University, Kocaeli, Turkey.
BMC Anesthesiol. 2025 Jul 1;25(1):320. doi: 10.1186/s12871-025-03193-w.
Pain management in pediatric patients is of utmost importance to ensure their well-being and prompt recovery. Current analgesia methods are not always sufficient, leading to suboptimal pain control and increased morbidity. Almost 80% of patients undergoing surgery experience postoperative pain. Results of many studies show that treatment of postoperative pain in children is inadequate. As such, in recent years, there has been growing interest in fascial plane blocks. Fascial plane blocks involve the injection of local anesthetics into the fascial planes surrounding targeted nerves, providing prolonged analgesia with reduced risk of systemic side effects. Studies have shown the efficacy of fascial plane blocks in providing effective analgesia for a variety of surgical procedures, including abdominal, thoracic, and orthopedic surgeries. With careful patient selection and appropriate technique, use of fascial plane blocks in pediatric patients can improve the quality of postoperative pain management, reducing the risk of adverse effects associated with systemic analgesics or well-known classical neuraxial regional anesthesia techniques. In addition to better pain control, the use of fascial plane blocks, as a part of multimodal analgesia regimen, may also reduce the need for opioid analgesics, thereby decreasing the risk of opioid-related adverse effects such as respiratory depression. In conclusion, fascial plane blocks represent a promising alternative to traditional analgesia methods for pediatric patients undergoing surgery. While further research is needed to establish their safety and efficacy for specific procedures in pediatric patients, the available evidence suggests that they may offer significant benefits in terms of pain management. Although fascial plane blocks are volume-dependent techniques, to minimize the risk of local anesthetic systemic toxicity, it is advisable to avoid using more than 0.3-0.5 mL/kg of local anesthetic and to prefer lower concentrations.
小儿患者的疼痛管理对于确保其健康和快速康复至关重要。当前的镇痛方法往往并不充分，导致疼痛控制不理想且发病率增加。几乎80%接受手术的患者会经历术后疼痛。许多研究结果表明，儿童术后疼痛的治疗并不充分。因此，近年来，人们对筋膜平面阻滞的兴趣日益浓厚。筋膜平面阻滞是将局部麻醉药注射到目标神经周围的筋膜平面，可提供长时间的镇痛效果，同时降低全身副作用的风险。研究表明，筋膜平面阻滞对于包括腹部、胸部和骨科手术在内的各种外科手术都能提供有效的镇痛作用。通过仔细的患者选择和适当的技术，在小儿患者中使用筋膜平面阻滞可以提高术后疼痛管理的质量，降低与全身镇痛药或著名的经典椎管内区域麻醉技术相关的不良反应风险。除了更好的疼痛控制外，作为多模式镇痛方案的一部分，使用筋膜平面阻滞还可能减少对阿片类镇痛药的需求，从而降低阿片类药物相关不良反应（如呼吸抑制）的风险。总之，对于接受手术的小儿患者，筋膜平面阻滞是传统镇痛方法的一种有前景的替代方法。虽然需要进一步研究以确定其在小儿患者特定手术中的安全性和有效性，但现有证据表明，它们在疼痛管理方面可能带来显著益处。尽管筋膜平面阻滞是依赖容量的技术，但为了将局部麻醉药全身毒性的风险降至最低，建议避免使用超过0.3 - 0.5 mL/kg的局部麻醉药，并优先选择较低浓度。
