الفهرس 
AcknowledgementOnly 14 pages are availabe for public view
 |  | from | 53 |  |  |
| | | from | 53 | | |
Abstract
In children, regional anesthetic techniques are safe and effective adjuncts to general anesthesia and for postoperative pain relief. Application of the techniques described in this article will contribute to improved care for pediatric patients undergoing surgical procedures. The judicious choice of local anaesthetics, along with the blockades of targeted nerves, decreases the need for supplemental analgesics in the recovery phase.
Regional anesthesia has been found to be more costly as compared to general anesthesia. The drugs and equipment required are more expensive but the length of hospital stay is usually shorter. It avoids the need for an anaesthetic machine. There is less post-operative sedation and nausea, and a faster return to “normal”. However, most regional blocks in children are done with the child asleep. Even so, with a block in place less anaesthetic will be needed to keep the child asleep, there is less surgical stress response, and analgesia lasts into the post-operative period.
Regional anaesthesia is contraindicated only either absolutely in major coagulation disorders, infection at the site of needle insertion and patient refusal (parents of the patient) or relatively in shocked or severely hypovolaemic patient, anticipated technical difficulty, unexperienced anaesthetist, neurological disease (e.g. multiple sclerosis) and uncertain duration of surgery (the surgery may outlast the block, but in an asleep patient the block can be repeated, or placed at the end of the operation).
In conclusion, a large variety of local and regional anaesthetic techniques can be safely used in neonatal patients. The use of such techniques must obviously be associated with sufficient knowledge about regional differences in vertebral structure, anatomical and physiological differences between adults and pediatrics, chemistry, pharmacodynamics, and pharmacokinetics of local anaesthetic drugs, the various techniques, as well as adherence to adequate dosage guidelines and other safety precautions. However, if these prerequisites are met, regional anaesthesia may offer great advantages to our smallest and most vulnerable patients.
So, practically we benefit that the regional anaesthetic techniques can be used in all pediatric age groups including neonates and premature babies, both central and peripheral nerve-blocking techniques are associated with adequate safety if performed according to established practice, as in adult regional anaesthesia practice, the current trend in pediatrics is to more frequently use peripheral nerve blocking techniques as compared with central approaches, including the use of continuous catheter techniques. The use of ultrasound guidance offers clear advantages when used in association with most peripheral nerve-blocking techniques. The advantages, when used in association with central nerve blocks, are less clear at present. Clonidine can be used as an adjunct both to central and peripheral nerve blocks. An emerging trend in pediatric regional anaesthesia is the use of wound catheter techniques.
Pediatric regional anesthesia may have been con¬ceptualized years ago but its golden years are yet to come. Overall patient safety, feasibility and reliabil¬ity are the key features of this technique which will only become better with greater use, experience and re¬search.