Current opinion in anaesthesiology · 2026
Current controversies in paediatric regional anaesthesia.
СтатьяОбзорНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
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Jackson Sarah, Burton Zoe, Pearson Annabel
Аннотация
PURPOSE OF REVIEW: Regional anaesthesia has well established benefits in paediatric perioperative care and acute pain interventions. This article explores current controversies and emerging evidence in paediatric regional anaesthesia.
RECENT FINDINGS: Despite rates of local anaesthetic systemic toxicity (LAST) remaining low, dosing of local anaesthetics in children remains controversial, particularly in neonates, in whom maximum safe doses can easily be exceeded. Local anaesthetic additives, such as dexamethasone, dexmedetomidine, and clonidine, are commonly used to prolong regional anaesthesia and have demonstrated good efficacy and safety, though best route of administration remains debated. Peripheral nerve catheters prolong analgesia and can be safely managed in ambulatory settings. Enhanced recovery after surgery (ERAS) is rapidly expanding in paediatric anaesthesia, and regional anaesthesia forms a key component. Fear of masking compartment syndrome is not supported by current literature and not a contraindication to regional anaesthesia. Studies exploring the utility of awake regional anaesthesia in children have successfully demonstrated the avoidance of general anaesthesia. Anaesthetic training increasingly demands proficiency in ultrasound-guided regional techniques.
SUMMARY: Regional anaesthesia is a safe and effective analgesic modality in children, including in trauma patients and as part of ERAS protocols, with good evidence for use of additives and low rates of complications, including LAST.
RECENT FINDINGS: Despite rates of local anaesthetic systemic toxicity (LAST) remaining low, dosing of local anaesthetics in children remains controversial, particularly in neonates, in whom maximum safe doses can easily be exceeded. Local anaesthetic additives, such as dexamethasone, dexmedetomidine, and clonidine, are commonly used to prolong regional anaesthesia and have demonstrated good efficacy and safety, though best route of administration remains debated. Peripheral nerve catheters prolong analgesia and can be safely managed in ambulatory settings. Enhanced recovery after surgery (ERAS) is rapidly expanding in paediatric anaesthesia, and regional anaesthesia forms a key component. Fear of masking compartment syndrome is not supported by current literature and not a contraindication to regional anaesthesia. Studies exploring the utility of awake regional anaesthesia in children have successfully demonstrated the avoidance of general anaesthesia. Anaesthetic training increasingly demands proficiency in ultrasound-guided regional techniques.
SUMMARY: Regional anaesthesia is a safe and effective analgesic modality in children, including in trauma patients and as part of ERAS protocols, with good evidence for use of additives and low rates of complications, including LAST.