Paediatric regional anaesthesia for surgical procedures : A guide to drug choice

Paediatric regional anaesthesia plays an important role in stress reduction and perioperative pain control. Aminoamide local anaesthetics such as mepivacaine, bupivacaine and, more recently, ropivacaine are widely used. Because of the differences in anatomy and physiology between children and adults...

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Bibliographic Details
Published in:CNS drugs 1999-11, Vol.12 (5), p.357-368
Main Authors: IVANI, G, DE NEGRI, P, CONIO, A
Format: Article
Language:English
Subjects:
Anesthetics. Neuromuscular blocking agents
Biological and medical sciences
Medical sciences
Neuropharmacology
Pharmacology. Drug treatments
Online Access:Get full text
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Summary:Paediatric regional anaesthesia plays an important role in stress reduction and perioperative pain control. Aminoamide local anaesthetics such as mepivacaine, bupivacaine and, more recently, ropivacaine are widely used. Because of the differences in anatomy and physiology between children and adults, low concentrations and high volumes have to be used to ensure that these drugs are effective and well tolerated in paediatric patients. Mepivacaine, because of its short duration of effect, is mainly used for brief procedures, while the long-lasting action of bupivacaine makes it the most commonly used local anaesthetic for both single dose administration and continuous infusion through an epidural catheter. Ropivacaine, the N-propyl homologue of bupivacaine [available only as the pure S-(-)-enantiomer], has only recently been introduced for use in children, but the results of preliminary studies suggest that it will probably have a predominant place in paediatrics. Adjuvants are often administered to prolong the action of local anaesthetics in the postoperative period. Epinephrine (adrenaline) and opioids were used for many years as adjuvants. While opioids still have a place in regional anaesthesia, their adverse effects (mainly respiratory depression) require that they are used in combination with accurate monitoring of vital parameters. Nowadays, clonidine and ketamine are more likely to be used as adjuvants and they have been associated with impressive results. Clonidine 1 to 2 mu g/kg prolongs the action of mepivacaine, bupivacaine and ropivacaine and neither hypotension nor respiratory depression have been described. The only adverse effect of clonidine is sedation, which is often useful in the postoperative period in children. Ketamine seems to be the most effective of the adjuvants; preliminary results indicate that it can prolong analgesia for at least 10 hours, but these findings require confirmation.
ISSN:1172-7047
1179-1934
DOI:10.2165/00023210-199912050-00003