Equipment and Safety Conditions (con't)

Avoiding complications

Experience and proper training of the anesthesia team are of paramount importance when performing peripheral nerve blocks. These blocks in children should only be performed in an operating theater environment with the same monitoring and other safety procedures recom-mended for a general anesthetic. Prior to any block performance, establishment of an intra-venous line [40] and cardiovascular monitoring (i.e., EKG, blood pressure, respiratory rate and pulse oxymetry) must be instituted. Vital signs as well as the agents, doses and techniques used should be recorded on a complete anesthesia chart.

While peripheral nerve blocks in adults are typically performed in conscious, lightly sedated patients, most children fear needle punctures and thus require a heavy sedation or a general anesthetic for block performance. If not contraindicated for medical reasons (poor physical status, full stomach etc.), light general anesthesia can be safely used and is both very com-monly practiced and widely accepted in pediatric anesthesia practice [41]. The technique of injection is a key factor of safety and early diagnosis of complications. All block procedures require that an aspiration test and evaluation of a test dose (with 0.5 to 1 µg/Kg of epine-phrine if not contra-indicated) be performed before large amounts of local anesthetic are injected. The injection must be performed slowly and any unusual resistance requires imme-diate cessation of the technique.