- Paediatric local anaesthesia
- Safety considerations
- Reduce initial dose in neonates to 50% from equivalent adult dose and also infusion dose
- Reduce epidural rate by 1/3 after 24 hrs in children
- Technical issues
- Care with positioning
- Airway obstruction can occur in the sitting position in babies due to lack of head control
- Flexion of the head/legs in lateral position can cause diaphragmatic splinting
- False occlusion alarms due to fine catheters
- Care with pressure areas, burns, positioning
- Techniques in conscious infants
- Topical
- Lidocaine gel after circumcision
- Installation for wounds
- Caudal block
- SAB useful in ex-pre-term neonate for herniotomy in expert hands
- 0.1ml/kg of 0.5% bupivicaine used
- Extra 0.1-0.2 ml used for dead space of needle
- Short surgical anaesthesia time (20-60 mins)
- Techniques for major surgery under GA
- Peripheral nerve blocks
- Intercostal nerve blocks for thoracoabdominal or renal surgery
- Can be done by surgeon
- Plexus block
- Paravertebral block via catheter
- Surgeon placed or percutaneously placed
- Central neuraxial blockade
- Caudal catheter
- Lumbar epidural catheter
- Thoracic epidural
- Techniques in minor/intermediate surgery under GA
- Topical LA
- Infiltration
- Dressings soaked in dilute LA useful for donor sites
- Peripheral nerve blocks
- Penile block (terminal branch of the pudendal nerve)
- 0.1ml/kg of 0.5% bupivicaine is safe
- Ilioinguinal/iliohypogastric nerve
- Injection of LA 1 finger breadth medial to the ASIS deep to external oblique will block both nerves
- Rectus sheath block
- Perpendicular to abdominal wall, 1cm medial to lateral border of rectus muscle
- Paravertebral block
- Metacarpal/metatarsal blocks
- Infra orbital nerve block
- Caudal block
- CEACCP
Link:ceaccp.oxfordjournals.org/content/4/5/148.full.pdf?sid=7ef724cf-999f-4d1f-96a7-0bfecdafe114