Lejus C, Saunier H
Département d'Anesthésie-Réanimation Chirurgicale, Hôtel-Dieu, Nantes.
Cah Anesthesiol. 1995;43(6):533-40.
Regional anaesthesia has been increasingly popular in paediatric patients of all ages, especially because some techniques afford excellent per and post-operative pain relief. However, side effects may occur. Particularly, systemic toxicity from bupivacaine administration is associated with intravascular injection or overdosage. Then, we focused anaesthesiologist's attention on some inconvenients related with these practices. Regional blockade is most of the time performed in conjunction with general anaesthesia. Consequently, these procedures need additional time, material and nurses. There are relatively few absolute indications for regional anaesthesia in children. The decision for using these techniques is influenced by several factors as incidence of complications, local technical expertise. Alternative methods to provide per and post-operative analgesia being available, advantages and side effects of loco-regional anaesthesia have to be opposited. Management of the best method of block, doses and local anaesthetics or adjuvants according age, requires likely specific teaching in training team. An effort to provide appropriate guidelines and training to ward nurses is necessary to improve security when regional blockade is used for postoperative analgesia. In every cases, physician's experience is the best argument of choice.
区域麻醉在各年龄段的儿科患者中越来越受欢迎，特别是因为一些技术能提供出色的术中和术后疼痛缓解。然而，可能会出现副作用。尤其是，布比卡因给药引起的全身毒性与血管内注射或过量用药有关。然后，我们让麻醉医生关注与这些操作相关的一些不便之处。区域阻滞大多时候是与全身麻醉联合进行的。因此，这些操作需要额外的时间、材料和护士。儿童区域麻醉的绝对适应证相对较少。使用这些技术的决定受到多种因素影响，如并发症发生率、当地技术专长等。由于有其他提供术中和术后镇痛的方法，必须权衡局部区域麻醉的优缺点。根据年龄管理最佳的阻滞方法、剂量以及局部麻醉药或佐剂，可能需要在培训团队中进行专门教学。当区域阻滞用于术后镇痛时，努力为病房护士提供适当的指导和培训对于提高安全性是必要的。在每种情况下，医生的经验是选择的最佳依据。
