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LOCAL ANAESTHESTICS AND PERIPHERAL BLOCKS
Author(s):
Ivani, G.*
Affiliations:
Regina Margherita Children's Hospital, Pediatric Anesthesiology and Intensive Care, Turin, Italy
ESRA Academy. Ivani G. Sep 15, 2017; 196164; esra7-0487
Prof. Giorgio Ivani
Prof. Giorgio Ivani
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Abstract
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Central blocks  were from the very beginning of pediatric regional anesthesia (PRA) the most commonly used and among them the caudal block  was the most popular  More recently the use of the ultrasound technique applied to PRA increased the approaches and techniques of peripheral blocks

Many papers described the use of local anesthetics and adjuvants for central blocks , dose and concentration well documented; it was different so far for peripheral blocks where most of the papers are review or databases describing the safety and efficacy of peripheral blocks but only few studies compare the “old” bupivacaine to the “new” drugs such as levobupivacaine and ropivacaine or their pharmacokinetics ..Moreover the different peripheral blocks (from upper to lower extremity blocks, fascial plane blocks  etc ) require different volumes and concentrations

Once again ESRA and ASRA created a Board in order to have new  recommendations describing the suggested doses and concentrations of local anesthtetics for the different approaches ,using the ultrasound technique,dividing the peripheral blocks in upper and lower extremity blocks, fascial plane blocks for a single shot and for a continuous infusion with the respective evidence grade

 

Upper and lower extremity blocks (eg axillary, infra and supraclavicular , interscalene,sciatic,femoral):

bupivacaine,levopubivacaine or ropivacaine of 0.5-1.5 mg/kg

 

Fascial plane blocks ( eg transversus abdominis plane,rectus sheath ,ilioinguinal iliohypogastric blocks)

bupivacaine or ropivacaine of 0.25-0.75 mg/kg

Continuous infusion of local anesthetic for peripheral nerve and fascial plane blocks :

 0.2% ropivacaine or bupivacaine using an infusion dose of 0.1-0.3 mg/kg/kr

 

 

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