Neuraxial blockade in children

Moriarty, Tony; Brown, Rachel

doi:10.1016/j.mpaic.2007.02.009

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Volume 8, Issue 5 , Pages 194-199, May 2007

Neuraxial blockade in children

Tony Moriarty, FRCA, is Consultant Paediatric Anaesthetist at Birmingham Children's Hospital, UK. He qualified at St Thomas' Hospital Medical School and trained in Paediatric Anaesthesia at Great Ormond Street, London, Norwich, Cambridge, Birmingham and U C Irvine, California. His interests include paediatric epidural analgesia and paediatric cardiac and ENT anaesthesia

Rachel Brown, FRCA, was clinical fellow at Birmingham Children's Hospital and is Specialist Registrar on the South West Peninsular training scheme. She qualified at the University of Bristol, and is specializing in general paediatric anaesthesia

Abstract

Epidural blockade in children has become more popular for postoperative analgesia in recent years owing to increased experience, greater confidence and the development of appropriate equipment. In the UK, approximately 2000 lumbar epidural and continuous caudal blocks are performed each year. Spinal anaesthesia remains popular for babies at risk of postoperative apnoea, but is being superseded by light general anaesthesia with desflurane or sevoflurane combined with caudal blockade. Contraindications to neuraxial blockade include patient or parental refusal, coagulation abnormalities, septicaemia, raised intracranial pressure, meningitis, infection at the entry site, allergy to local anaesthetics, myelomeningocele (spina bifida) and abnormal sacral anatomy for a caudal epidural.

Keywords: children, complications, epidural, spinal