Use of local anaesthetics in children
Use of local anaesthetics in children |
Introduction
Local anaesthetics provide excellent pain relief, are an important part of multimodal analgesia, and can significantly decrease opioid requirements. It is important that the total dose of local anaesthetic does not exceed the maximum doses. Appropriate resuscitation equipment and personnel should be available for the management of local anaesthetic toxicity.
For topical and transdermal administration,
Local infiltration should be used routinely in children for surgery and for procedures such as intravenous cannulation or lumbar puncture. Buffered lignocaine causes minimal pain when used with local infiltration, and works rapidly.
Do not use adrenaline-containing solutions in end-artery regions (eg digits, penis).
Regional blocks
Femoral nerve block and axillary brachial plexus block are examples of regional blocks.
Use of these blocks requires a detailed knowledge of the relevant anatomy, and an intravenous cannula should be inserted before the block, in case there is an adverse reaction.
A volume of 0.5 mL/kg of local anaesthetic agent is usually required. The concentration of local anaesthetic may need to be decreased to avoid toxicity.
Many peripheral nerve blocks are performed under general anaesthesia for postoperative pain control. Care should be taken with dressings, pressure areas, and positioning, because that part of the body will have no sensation.
Central neural blocks
(eg epidural administration of local anaesthetic and opioid drugs) should only be performed by experienced practitioners (eg paediatric anaesthetists) and only in institutions where there is expertise to care for these children. They are usually inserted under general anaesthesia and can provide excellent analgesia after major surgery.
The anatomy of the paediatric epidural space differs from that of the adult in that it is:
relatively superficial in a child compared with an adult
less densely packed with fat, so that relatively larger volumes of local anaesthetic are required.
Maximum paediatric local anaesthetic single dose by any route (Table 1.20)
| Drug | Maximum dose (mg/kg) |
lignocaine without adrenaline | 5 |
lignocaine with adrenaline | 7 |
bupivacaine with or without adrenaline | 2.5 |
ropivacaine with or without adrenaline | 2 to 3 |
levobupivacaine with or without adrenaline | 2.5 |
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