SP38.1 Update on adjuvants for paediatric PNBs
摘要
<h3></h3> Karolinska Institute, Stockholm, Sweden <b>This is an excerpt from the publication:</b> Suresh S, Ecoffey C, Bosenberg A, Lonnqvist PA, de Oliveira GS Jr, de Leon Casasola O, de Andrés J, Ivani G. The European Society of Regional Anaesthesia and Pain Therapy/American Society of Regional Anesthesia and Pain Medicine Recommendations on Local Anesthetics and Adjuvants Dosage in Pediatric Regional Anesthesia. Reg Anesth Pain Med. 2018 Feb;43(2):211–216. doi: 10.1097/AAP.0000000000000702. PMID: 29319604. Adjuvants in Pediatric regional Anesthesia Per-Arne Lönnqvist <h3>Initial word of caution/Disclaimer</h3> With the exception of clonidine and preservative free morphine none of the other adjuvant agents mentioned in this practice advisory guideline are registered for spinal/epidural administration. None of the agents are registered for injection close to peripheral nerve structures. Thus, the decision to use the drugs mentioned below as adjuvants to pediatric regional anesthesia will be governed by the individual practitioner´s decision, departmental policy and the existing medicolegal situation. Rational for using adjuvants Even long-acting local anesthetics (racemic bupivacaine, levo-bupivacaine and ropivacaine) have a limited duration of action (typically 4–12 h of duration) balanced against the time period of more intense postoperative pain associated with moderate or major surgery (24–72 h). Prolongation of the block effect in order to better match pain duration can be accomplished by the use of catheter techniques that will allow repeated bolus administration or continuous infusion of local anesthetics.<sup>1</sup> However, the majority of pediatric surgical interventions do not merit the use of these more complicated and resource demanding options for postoperative analgesia. Thus, a popular alternative to achieve prolongation of a single injection nerve block is to use adjuvant drugs that are mixed with the local anesthetics and thereby increase the dur