Local anaesthetic dosage of peripheral nerve blocks in children: analysis of 40,121 blocks from the Paediatric Regional Anaesthesia Network database
There is limited data available on the efficacy or safety of single shot peripheral nerve blocks in the paediatric population. Currently, no consensus clinical practice guidelines exist on the appropriate dose of local anaesthetic for single shot nerve blocks in children. This review used the Paediatric Regional Anaesthesia Network (PRAN) database. The database has 20 participating sites, to track every recorded single shot peripheral nerve block in children under 18 years of age over an 8 year period.
Just over 40,000 blocks were included in this review. 93% of the blocks were placed under a general anaesthetic with Ropivacaine being the most commonly used local anaesthetic (59 %). There was a 5-10 fold variability in local anaesthetic dose depending on the type of block performed. Only 2 patients developed local anaesthetic toxicity, an incidence of 0.005%. No short or long term complications related to the local anaesthetic toxicity were reported. 75% of the blocks were placed with use of both ultrasound and nerve stimulator concomitantly. The use of ultrasound for block placement increased significantly over the study years. The use of epinephrine as a block adjuvant with either Bupivacaine or Ropivacaine was associated with larger local anaesthetic doses used, than when done without. (P<0.001)
Take home message:
The review points to overall safety of peripheral nerve blocks in the paediatric population with low incidence of complications. There was a huge variation in the dosage of local anaesthetic used, although the incidence of systemic local anaesthetic toxicity was low. The use of ultrasound has resulted in increasing popularity of peripheral nerve blocks in the paediatric population and therefore there needs to be a clearer guideline for a safe and effective local anaesthetic dose for various blocks in order to reduce the variability in practice that currently exists.
Reviewed by: Dr. Priya Sreedharan