Abstract
In the first edition of “Complications in Regional Anesthesia,” Broadman 1 produced a chapter that essentially reported a synopsis of all of the complications that were available at that time in the English-language literature that were associated with the placement of regional blocks in infants and children, and the limited safety record associated with caudal block placements. The caudal block safety record was based on three moderately sized series, 750–7800 blocks, which had been safely performed by anesthesiologists that are now recognized authorities in the field of pediatric regional anesthesia. 2–4 All of the potential problems or complications associated with the placement of regional anesthesia blocks at the time of the first writing were unfortunately derived from single case reports.
Access provided by Autonomous University of Puebla. Download to read the full chapter text
Chapter PDF
Similar content being viewed by others
Keywords
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
References
Broadman LM. Complications of pediatric regional anesthesia. In: Finucane BT, ed. Complications of Regional Anesthesia. 2nd ed. Philadelphia: Churchill Livingstone; 1999: 245–256.
Dalens B, Hasnouai A. Caudal anesthesia in pediatric surgery: success rate and adverse effects in 750 consecutive patients. Anesth Analg 1989;68:83–89.
Broadman LM, Rice LJ. Neural blockade for pediatric surgery. In: Cousins MJ, Briden-baugh PO, eds. Neural Blockade in Clinical Anesthesia and Pain Management. 3rd ed. Philadelphia: JB Lippincott; 1998:615–636.
Veyckemans F, Van Obbergh LJ, Gouverneur JM. Lessons from 1100 pediatric caudal blocks in a teaching hospital. Reg Anesth 1992;17:119–125.
Giaufré E, Dalens B, Gombert A. Epidemiology and morbidity of regional anesthesia in children: a one-year prospective survey of the French-Language Society of Pediatric Anesthesiologists. Anesth Analg 1996;83:904–912.
Cheney FW, Domino KB, Caplan RA, Posner KL. Nerve injury associated with anesthesia: a closed claims analysis. Anesthesiology 1999;90:1062–1069.
Fox MAL, Webb RK, Singleton R, et al. Problems with regional anaesthesia: an analysis of 2000 incident reports. Anaesth Intensive Care 1993;21:646–649.
Zadra N, Giusti F. Il Blocco caudale in pediatria. Minerva Anestesiol 2001;67(suppl 1): 126–131.
Puncuh F, Lampugnani E, Kokki H. Use of spinal anaesthesia in paediatric patients: a single centre experience with 1132 cases. Pediatr Anesth 2004;14:564–567.
Wee LH, Lam F, Cranston AJ. The incidence of post dural puncture headache in children. Anaesthesia 1996;51:1164–1166.
Fellmann C, Gerber AC, Weiss M. Apnoea in a former preterm infant after caudal bupivacaine with Clonidine for inguinal herniorrhaphy. Pediatr Anaesth 2002;12:637–640.
Guinard J-P, Borboen M. Probable venous air embolism during caudal anesthesia in a child. Anesth Analg 1993;76:1134–1135.
Schwartz N, Eisenkraft JB. Probable venous embolism during epidural placement in the infant. Anesth Analg 1993;76:1136–1138.
Nora JJ. Etiologic aspects of heart disease. In: Adams FH, Emmanouilides CG, eds. Heart Disease in Infants, Children and Adolescents. 3rd ed. Baltimore: Williams & Wilkins; 1983:14.
Desparmet J. Total spinal anesthesia after caudal anesthesia in an infant. Anesth Analg 1990;70:665–667.
Holt HM, Andersen SS, Andersen O, et al. Infections following epidural catheterization. J Hosp Infect 1995;30:253–260.
McNeely JK, Trentadue NC, Rusy LM, Farber NE. Culture of bacteria from lumbar and caudal epidural catheters used for postoperative analgesia in children. Reg Anesth 1997; 22:428–431.
Fujinaka W, Hinomoto N, Saeki S, et al. Decreased risk of catheter infection in infants and children using subcutaneous tunneling for continuous caudal anesthesia. Acta Med Okayama 2001;55:283–287.
Strafford MA, Wilder RT, Berde CB. The risk of infection from epidural analgesia in children. A review of 1620 cases. Anesth Analg 1995;80:234–238.
Baker AS, Ojemann RG, Swartz MN, Richardson EP. Spinal epidural abscess. N Engl J Med 1975;293:463–468.
Meunier JF, Norwood P, Dartayet B, et al. Skin abscess with lumbar epidural catheterization in infants. Is it dangerous? Report of two cases. Anesth Analg 1997;84:1248–1249.
Larsson BA, Lundberg S, Olsson GL. Epidural abscess in a one-year-old boy after continuous epidural analgesia. Anesth Analg 1997;84:1245–1247.
Roberts GJ, Simmons NB, Longhurst P, Hewitt PB. Bacteraemia following local anaesthetic injections in children. Br Dent J 1998;185:295–298.
Ecoffey C, Dubousset A-M, Samii K. Lumbar and thoracic epidural anesthesia for urologie and upper abdominal surgery in infants and children. Anesthesiology 1986;65:87–90.
Ruston FG. Epidural anaesthesia in infants and children. Can Anaesth Soc J 1954;1: 37–40.
Bösenberg AT, Bland BAR, Schulte-Steinberg O, Downing JW. Thoracic epidural anesthesia via caudal route in infants. Anesthesiology 1988;69:265–269.
Gunter JB, Eng C. Thoracic epidural anesthesia via the caudal approach in children. Anesthesiology 1992;76:935–938.
Blanco D, Llamazares J, Rincón R, et al. Thoracic epidural anesthesia via the lumbar approach in infants and children. Anesthesiology 1996;84:1312–1316.
Raskin NH. Lumbar puncture headache: a review. Headache 1990;30:197–200.
Tobias JD. Postdural puncture headache in children: etiology and treatment. Clin Pediatr 1990;33:110–113.
McHale J, O’Donovan FC. Postdural puncture symptoms in a child. Anaesthesia 1997; 52:688–690.
Purtock RV, Buhl JL, Abram SE. Epidural blood patch in a nine-year-old boy. Reg Anesth 1984;9:154–155.
Roy L, Vischoff D, Lavoie J. Epidural blood patch in a seven-year-old child. Can J Anaesth 1995;42:621–624.
Kumar V, Maves T, Barcellos W. Epidural blood patch for treatment of subarachnoid fistula in children. Anaesthesia 1991;46:117–118.
Desparmet J, Mateo J, Ecoffey C, Mazoit X. Efficiency of an epidural test dose in children anesthetized with halothane. Anesthesiology 1990;72:249–251.
Perillo M, Sethna NF, Berde CB. Intravenous isoproterenol as a marker for epidural testdosing in children. Anesth Analg 1993;76:178–181.
Tucker GT. Pharmacokinetics of local anaesthetics. Br J Anaesth 1986;58:717–731.
Sethna NF, Berde CB. Pediatric regional anesthesia. In: Gregory G, ed. Pediatric Anesthesia. 3rd ed. New York: Churchill Livingstone; 1994:281–317.
Morgan D, McQuillan D, Thomas J. Pharmacokinetics and metabolism of the anilide local anesthetics in neonates. Eur J Clin Pharmacol 1978;13:365–371.
Mazoit JX, Denson DD, Samii K. Pharmacokinetics of bupivacaine following caudal anesthesia in infants. Anesthesiology 1988;68:387–391.
Lerman J, Strong HA, Le Dez KM, et al. Effects of age on serum concentration of alpharacid glycoprotein and the binding of lidocaine in pediatric patients. Clin Pharmacol Ther 1989;46:219–245.
Eyres RL, Kidd J, Oppenheimer R, Brown TCK. Local anaesthetic plasma levels in children. Anaesth Intensive Care 1978;6:243–247.
Rosen MA, Thigpen JW, Shnider S, et al. Bupivacaine-induced cardiotoxicity in hypoxic and acidotic sheep. Anesth Analg 1985;64:1089–1096.
Heavner JE, Dryden CF, Sanghani V, et al. Severe hypoxia enhances central nervous system and cardiovascular toxicity of bupivacaine in lightly anesthetized pigs. Anesthesiology 1992;77:142–147.
Timour Q, Freysz M, Mazze R, et al. Enhancement by hyponatremia and hyperkalemia of ventricular conduction and rhythm disorders caused by bupivacaine. Anesthesiology 1990;72:1051–1056.
Scott DB. Evaluation of clinical tolerance of local anesthetic agents. Br J Anaesth 1975; 47:328–333.
Eyres RL, Hastings C, Brown TCK, Oppenheim RC. Plasma bupivacaine concentrations following lumbar epidural anesthesia in children. Anaesth Intensive Care 1986;14: 131–134.
Eyres RL, Bishop W, Oppenheim RC, Brown TCK. Plasma bupivacaine concentrations in children during caudal epidural analgesia. Anesth Intensive Care 1983;11:20–26.
Stow PJ, Scott A, Phillips A, White JB. Plasma bupivacaine concentrations during caudal analgesia and ilioinguinal-iliohypogastric nerve block in children. Anaesthesia 1988; 43:650–653.
Desparmet J, Meistelman C, Barre J, Saint-Maurice C. Continuous epidural infusion of bupivacaine for postoperative pain relief in children. Anesthesiology 1987;67:108–110.
Richter O, Klein K, Abel J, et al. The kinetics of bupivacaine plasma concentrations during epidural anesthesia following intraoperative bolus injection and subsequent continuous infusion. Int J Clin Pharmacol Ther Toxicol 1984;22:611–617.
Mcllvaine WB, Knox RF, Fennessey PV, Goldstein M. Continuous infusion of bupivacaine via intrapleural catheter for analgesia after thoracotomy in children. Anesthesiology 1988; 69:261–264.
Agarwal R, Gutlove DP, Lockhart CH. Seizures occurring in pediatric patients receiving continuous infusion of bupivacaine. Anesth Analg 1992;75:284–286.
Ved SA, Pinosky M, Nicodemus H. Ventricular tachycardia and brief cardiovascular collapse in two infants after caudal anesthesia using a bupivacaine-epinephrine solution. Anesthesiology 1993;79:1121–1123.
Maxwell LG, Martin LD, Yaster M. Bupivacaine-induced cardiac toxicity in neonates: successful treatment with intravenous phenytoin. Anesthesiology 1994;80:682–686.
McCloskey JJ, Haun SE, Deshpande JK. Bupivacaine toxicity secondary to continuous caudal infusion in children. Anesth Analg 1992;75:287–290.
Berde CB. Convulsions associated with pediatric regional anesthesia. Anesth Analg 1992;75:164–166.
Klein SM, Pierce T, Rubin Y, et al. Successful resuscitation after ropivacaine-induced ventricular fibrillation. Anesth Analg 2003;97:901–903.
Crews JC, Rothman TE. Seizure after levobupivacaine for interscalene brachial plexus block. Anesth Analg 2003;96:1188–1190.
Ivani G, Lampugnani E, De Negri P, Lonnqvist P, Broadman L. Ropivacaine vs bupivacaine in major surgery in infants. Can J Anaesth 1999;46:467–469.
Broadman LM, Ivani G. Caudal blocks. Tech Reg Anesth Pain Manage 1999;3:150–156.
Ala-Kokko TI, Karinen J, Raiha E, et al. Pharmacokinetics of 0.75% ropivacaine and 0.5% bupivacaine after ilioinguinal-iliohypogastric nerve block in children. Br J Anaesth 2002; 89:438–441.
Habre W, Bergesio R, Johnson C, et al. Pharmacokinetics of ropivacaine following caudal analgesia in children. Paediatr Anaesth 2000;10:143–147.
Deng XM, Xiao WJ, Tang GZ, et al. The minimum local anesthetic concentration of ropivacaine for caudal analgesia in children. Anesth Analg 2002;94:1465–1468.
Paut O, Schreiber E, Lacroix F, et al. High plasma ropivacaine concentrations after fascia iliaca compartment block in children. Br J Anaesth 2004;92:416–418.
Van Obbergh LJ, Roelants FA, Veyckemans F, Verbeeck RK. In children, the addition of epinephrine modifies the pharmacokinetics of ropivacaine injected caudally. Can J Anaesth 2003;50:593–598.
Morrison SG, Dominguez JJ, Frascarolo P, Reiz S. A comparison of the electrocardiographic cardiotoxic effects of racemic bupivacaine, levobupivacaine, and ropivacaine in anesthetized swine. Anesth Analg 2000;90:1308–1314.
Nichols D, Yaster M, Lynn A, et al. Disposition and respiratory effects of intrathecal morphine in children. Anesthesiology 1993;79:733–738.
Attia J, Ecoffey C, Sandouk P, et al. Epidural morphine in children. Pharmacokinetics and CO2 sensitivity. Anesthesiology 1986;65:590–594.
Krane EJ, Tyler DC, Jacobson LE. The dose response of caudal morphine in children. Anesthesiology 1989;71:48–52.
Krane EJ. Delayed respiratory depression in a child after caudal epidural morphine. Anesth Analg 1988;67:79–82.
Valley RD, Bailey AG. Caudal morphine for postoperative analgesia in infants and children: a report of 138 cases. Anesth Analg 1991;72:120–124.
Bailey AG, Valley RD, Freid EB, Calhoun P. Epidural morphine combined with epidural or intravenous butorphanol for postoperative analgesia in pediatric patients. Anesth Analg 1994;79:340–344.
Lawhorn CD, Brown RE. Epidural morphine with butorphanol in pediatric patients. J Clin Anesth 1994;6:91–94.
Jamail S, Monin S, Begon C, et al. Clonidine in pediatric caudal anesthesia. Anesth Analg 1994;78:663–666.
Callow LB, Rosen DA, Rosen KR, et al. Optimal pain relief following cardiac surgery in children. Circulation 1992;86:1–501.
Huang JJ, Hirshberg G. Regional anaesthesia decreases the need for postoperative mechanical ventilation in very low birth weight infants undergoing herniorrhaphy. Paediatr Anaesth 2001;11:705–709.
Tuncer S, Yosunkaya A, Reisli R, et al. Effect of caudal block on stress responses in children. Pediatr Int 2004;46:53–57.
Rosen D, Rosen KR, Hammer GB. Pro: regional anesthesia is an important component of the anesthetic technique for pediatric patients undergoing cardiac surgical procedures. J Cardiothorac Vasc Anesth 2002;16:374–378.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2007 Springer Science+Business Media, LLC
About this chapter
Cite this chapter
Broadman, L.M., Holt, R.A. (2007). The Evidence-Based Safety of Pediatric Regional Anesthesia and Complications. In: Finucane, B.T. (eds) Complications of Regional Anesthesia. Springer, New York, NY. https://doi.org/10.1007/978-0-387-68904-3_13
Download citation
DOI: https://doi.org/10.1007/978-0-387-68904-3_13
Publisher Name: Springer, New York, NY
Print ISBN: 978-0-387-37559-5
Online ISBN: 978-0-387-68904-3
eBook Packages: MedicineMedicine (R0)