Continuous central and perineural infusions for postoperative pain control in children.
OBJECTIVE
Continuous infusion remains the technique of choice when there is a prolonged operation or intense postoperative pain is anticipated. Supplementing a general anesthesia with a nerve block can result in a pain-free awakening and postoperative analgesia without the potentially deleterious effects associated with parenteral opioids. The literature confirms the very low rate of complications and adverse effects of regional anesthesia in children.


RESULTS
Clinicians need to be aware of the key points for performing a block and placing a catheter in children: good knowledge of anatomic and physiologic differences between adults and children is necessary; the use of newer local anesthetics, such as ropivacaine and levobupivacaine, increases the therapeutic window; and moreover it is mandatory to work with dedicated pediatric equipment.


CONCLUSIONS
The introduction of high-resolution portable ultrasound brought a great advance for the pediatric anesthesiologists; ultrasound-guided visualization of anatomic structures, in fact, allows greater precision of needle and catheter placement, and confirmation that the drug is deposited in the site of choice. This article reviews the safety and efficacy of central and perineural continuous infusions for postoperative pain control in children.
Ivani
Giorgio
G
Division of Pediatric Anesthesia and Intensive Care, Department of Anesthesia and Intensive Care, Regina Margherita Children Hospital, Torino, Italy. gioivani@libero.it
Mossetti
Valeria
V
D015360:Analgesia, Epidural / Q000379:methods; D000700:Analgesics / Q000008:administration & dosage / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D002648:Child; D006801:Humans; D007263:Infusions, Parenteral; D009407:Nerve Block / Q000379:methods; D010149:Postoperative Pain / Q000188:drug therapy*; D010525:Peripheral Nerves / Q000187:drug effects
D000700:Analgesics; D000701:Analgesics, Opioid