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

• Published in: Regional anesthesia and pain medicine Vol. 43; no. 2; pp. 211 - 216
• Main Authors: Suresh, Santhanam, Ecoffey, Claude, Bosenberg, Adrian, Lonnqvist, Per-Anne, de Oliveira, Gildasio S., de Leon Casasola, Oscar, de Andrés, José, Ivani, Giorgio
• Format: Journal Article
• Language: English
• Published: England Copyright by American Society of Regional Anesthesia and Pain Medicine 01.02.2018; BMJ Publishing Group LTD
• Subjects: Adjuvants; Age Factors; Age groups; Anesthesia, Conduction - adverse effects; Anesthesia, Conduction - standards; Anesthetics, Local - administration & dosage; Anesthetics, Local - adverse effects; Babies; Body Weight; Child; Child, Preschool; Consensus; Drug Dosage Calculations; Drug dosages; Humans; Infant; Infant, Newborn; Local anesthesia; Newborn babies; Pain management; Pain Management - adverse effects; Pain Management - standards; Pediatrics; Pediatrics - standards; Regional anesthesia; Spine; Treatment Outcome; Ultrasonography, Interventional - standards
• ISSN: 1098-7339; 1532-8651; 1532-8651
• DOI: 10.1097/AAP.0000000000000702

BACKGROUND AND OBJECTIVESDosage of local anesthetics (LAs) used for regional anesthesia in children is not well determined. In order to evaluate and come to a consensus regarding some of these controversial topics, The European Society of Regional Anaesthesia and Pain Therapy (ESRA) and the American Society of Regional Anesthesia and Pain Medicine (ASRA) developed a Joint Committee Practice Advisory on Local Anesthetics and Adjuvants Dosage in Pediatric Regional Anesthesia. METHODSRepresentatives from both ASRA and ESRA composed the joint committee practice advisory. Evidence-based recommendations were based on a systematic search of the literature. In cases where no literature was available, expert opinion was elicited. RESULTSSpinal anesthesia with bupivacaine can be performed with a dose of 1 mg/kg for newborn and/or infant and a dose of 0.5 mg/kg in older children (>1 year of age). Tetracaine 0.5% is recommended for spinal anesthesia (dose, 0.07–0.13 mL/kg). Ultrasound-guided upper-extremity peripheral nerve blocks (eg, axillary, infraclavicular, interscalene, supraclavicular) in children can be performed successfully and safely using a recommended LA dose of bupivacaine or ropivacaine of 0.5 to 1.5 mg/kg. Dexmedetomidine can be used as an adjunct to prolong the duration of peripheral nerve blocks in children. CONCLUSIONSHigh-level evidence is not yet available to guide dosage of LA used in regional blocks in children. The ASRA/ESRA recommendations intend to provide guidance in order to reduce the large variability of LA dosage currently observed in clinical practice.