Regional anesthesia for pediatrics
Hacer Şebnem Türk1, Canan Tülay Işıl1, Mehmet Eren Açık2, Naim Ediz1, Pınar Sayı1, Merih Tombul3, Sibel Oba1
1Şişli Etfal Eğitim ve Araştırma Hastanesi Anesteziyoloji ve Reanimasyon Kliniği, İstanbul, Turkey
2İstanbul Bilim Üniversitesi Anesteziyoloji ve Reanimasyon Anabilim Dalı, İstanbul, Turkey
3Sinop Devlet Hastanesi Anesteziyoloji ve Reanimasyon Kliniği, İstanbul, Turkey
Keywords: Pediatrics; postoperative analgesia; regional anesthesia.
Objectives: Relevancy to regional anesthesia in pediatrics has increased, because it is complementary to general anesthesia, allows conscious postoperative analgesia without respiratory depression, technical difficulties have been defeated and new local anesthetics have been improved. Therefore we reported data of patients who underwent pediatric surgery and received regional anesthesia.
Patients and methods: We retrospectively analyzed data of all patients, who were operated in the pediatric surgery clinic of our hospital during the time period from 1.01.2012-31.12.2012 and therefore received regional anesthesia. Total amount of operations and regional anesthesia, demographic variables, regional anesthesia techniques, supportive sedatives and general anesthesia requirements, agents used for anesthesia, diagnoses and complications were recorded.
Results: In the year 2012 a total of 2,116 patients were operated in our pediatric surgery clinic and 1,196 patients (713 boys, 483 girls, mean age 5.9±4.3 years; range 2 days to 17 years) received regional anesthesia. Caudal block was implemented in 718 patients, epidural block in 218 patients, ultrasonography (USG)-guided transversus-abdominis-plane (TAP)-block in 189 patients, USG-guided ilioinguinal-iliohypogastric block in 52 patients and spinal block in 19 patients. Average age of patients receiving caudal, epidural, TAP, ilioinguinal-iliohypogastric and spinal block was as follows: 3.1±2.3, 5.4±3.1, 3.6±2.8, 4.4±2.6 and 6.5±7.9 years. Levobupivacaine 0.25% was used in 868 patients, bupivacaine 0.25% in 309 patients, heavy bupivacaine 0.5% in 19 patients. Sedation in spinal anesthesia was done with midazolam and/or propofol, the other blocks were supportive to general anesthesia. Laryngeal mask airway was inserted into 981 of the patients and 196 patients were orotracheally intubated. No other complication was observed than hematoma due to USG-guided ilioinguinal-iliohypogastric block in one patient.
Conclusion: The importance of preventing postoperative pain should be considered in pediatrics and therefore advantage of regional anesthesia techniques should be taken. As far as differences in anatomy, physiology, pharmacology are well known, regional anesthesia is safe to apply in pediatrics.