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Paediatric caudal and epidural analgesia

机译：小儿尾硬膜外镇痛

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Purpose of review: Epidural blocks (caudal, lumbar or thoracic) are of common use in paediatric patients for special procedures such as open fundoplication as well as for postoperative analgesia. However, because neonates and infants have lower metabolic capacities and specific anatomies as compared to adults, the dose of local anaesthetics and the way of their administration need careful attention. Recent findings: Recent pharmacokinetic studies have more precisely identified the differences in pharmacokinetics between age groups, and between local anaesthetic agents. In that respect, ropivacaine exhibits a unique pharmacokinetic profile. Among all adjuvant drugs proposed so far, S-ketamine is promising; however, complete safety in case of injection into the cerebrospinal fluid must be checked before routine use. Thoracic epidural anaesthesia is technically difficult, and carries a potential risk of spinal cord puncture. Numerous techniques have been proposed to avoid this risk. The advancement of a catheter into the epidural space after caudal insertion has long been proposed by German and Italian authors, but for anatomical reasons, this technique is only possible in young infants. Some improvement of the original technique using lumbar insertion at the L4-L5 interspace has recently been suggested; the possibility of catheter guidance by means of electric stimulation has also been proposed. Summary: Pharmacokinetic studies allowing safer dosing, especially with ropivacaine have recently been published. New techniques of thoracic epidural with puncture at the lumbar level are also proposed. However, all these new techniques need to pass the test of time.
机译：审查目的：硬膜外阻滞（尾，腰或胸腔）在小儿患者中通常用于特殊手术，例如开放式胃底折叠术以及术后镇痛。然而，由于与成人相比，新生儿和婴儿的代谢能力和特定解剖结构较低，因此，局部麻醉剂的剂量及其给药方式需要特别注意。最新发现：最近的药代动力学研究更准确地确定了年龄组之间以及局部麻醉剂之间的药代动力学差异。在这方面，罗哌卡因具有独特的药代动力学特征。在迄今为止提出的所有辅助药物中，S-氯胺酮是有前途的。但是，在常规使用之前，必须检查注入脑脊液的完全安全性。胸膜硬膜外麻醉在技术上是困难的，并且具有脊髓穿刺的潜在风险。已经提出了许多技术来避免这种风险。德国和意大利的作者很久以来就提出将导管插入尾部硬膜外腔，但是由于解剖学原因，这种技术仅适用于年幼的婴儿。最近有人建议对在L4-L5间隙使用腰椎插入术的原始技术进行一些改进。还提出了通过电刺激引导导管的可能性。简介：最近发表了药代动力学研究，允许更安全地给药，尤其是罗哌卡因。还提出了在腰椎水平穿刺胸腔硬膜外的新技术。但是，所有这些新技术都需要通过时间的考验。

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