Epidemiology of regional anesthesia in children: Lessons learned from the European Multi-Institutional Study APRICOT
APRICOT (Anaesthesia Practice in Children Observational Trial) is a prospective observational multicentre cohort study examining more than 31,000 paediatric procedures in 33 European countries. This paper is the secondary analysis of this data to examine current practice in regional anaesthesia (RA).
Data was extracted from the APRICOT database which included all children (up to the age 16 years) undergoing anaesthesia in a consecutive 2-week period in 2014 or 2015. The choice of anaesthetic, RA technique, local anaesthetic agent and other medications were all analysed.
RA was administered in 4377 cases out of a total 22224 paediatric surgical procedures (19.6% of procedures). The most common RA was central blocks 42.6% (three-quarters of these being caudals) and truncal blocks 41.8%. Blocks were most frequently performed in children between 3 and 11 years. RA was mostly performed under general anaesthesia and using landmark techniques. Use of ultrasound was block dependent, being used for 96% of TAP blocks, and the majority of limb blocks (upper limb 66% and lower limb 70%). Nerve stimulation was used in 3.6% of cases, half of which were pudendal blocks.
The most frequently used local anaesthetics were levobupivacaine, ropivacaine and bupivacaine (37.6%, 37.1% and 24.2% respectively). Clonidine was used in almost 10% of cases. Only one side-effect was recorded – the administration of RA to the wrong side.
Take home message:
This study reinforces current knowledge about RA in paediatric anaesthesia – similar rates of administration, the common use of caudal blocks, the relatively low use of ultrasound and low complication rate. Although this study was not powered to examine complications and did involve long-term follow-up.
Reviewed by: Dr Patrick Cowie