Abstract

Pediatric applications of plexus and conduction nerve blocks have increased considerably in recent years, and they have indications in virtually all aspects of surgical and procedural pain, including outpatient surgery, whether the techniques are used in conscious patients or in combination with general anesthesia. Lower extremity nerve blocks remain underutilized despite their many advan-tages in terms of efficacy, safety and ease with which they can be performed with the help of a nerve stimulator. A major improvement in recent years consisted in the development of techniques allowing catheter placement for continuous infusion of local anesthetics.

Introduction

In recent years, pediatric applications of plexus and conduction nerve blocks have increased consi-derably and they have indications in virtually all aspects of surgical and procedural pain, including outpatient surgery, whether the techniques are used in conscious patients or in combination with general anesthesia.[1] Peripheral nerve blocks remain underutilized despite their unique ability to provide localized analgesia with small amounts of local anesthetics (LA). Two recent discoveries still reinforce this interest, especially for lower extremity nerve blocks: 1) sensitization of the peripheral nervous system plays a major role in sustaining postoperative pain and can be effectively preven-ted by conduction nerve blockade and not by opioid analgesia which is only effective on central sensitization whereas; 2) when discontinued, opioids exhibit pronociceptive effects which correlate with the doses and duration of treatment.[2,4] Consequently, there has been a resurge of an interest in the use of peripheral nerve blocks for management of postoperative pain, particularly now since the limitation of single-shot blockade (i.e., limited duration of analgesia), can be over-come with placement of catheters along nerve paths. It is likely that the use of both single-shot and continuous peripheral nerve blocks will significantly increase in the future as the quest for decreasing the psychological stress of surgery and overall costs of hospitalization continues.
 

Abstract

Introduction

Rationale

Indications

Contra-indications

Equipment

Techniques

Summary

References