Giorgio Ivani1, Santhanam Suresh, Claude Ecoffey, Adrian Bosenberg, Per-Anne Lonnqvist, Elliot Krane, Francis Veyckemans, David M Polaner, Marc Van de Velde, Joseph M Neal. 1. From the *Department of Anesthesiology, Regina Margherita Children's Hospital, Turin, Italy; †Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, IL; ‡Pôle Anesthésie-SAMU-Urgences-Réanimations, Hôpital Pontchaillou, Université Rennes 1, Rennes, France; §University of Washington and Seattle Children's Hospital, Seattle, WA; ∥Section of Anaesthesiology and Intensive Care, Department of Physiology and Pharmacology, Karolinska Institutet; and Paediatric Anaesthesia/PICU/ECMO Services, Karolinska University Hospital, Stockholm, Sweden; **Departments of Pediatrics, and Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA; ††Cliniques Universitaires St Luc, Catholic University of Louvain Medical School, Brussels, Belgium; ‡‡Departments of Anesthesiology and Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO; §§Department of Cardiovascular Sciences, KULeuven; and Department of Anesthesiology, UZLeuven, Leuven, Belgium; and ∥∥Department of Anesthesiology, Virginia Mason Medical Center, Seattle, WA.
Abstract
BACKGROUND AND OBJECTIVES: Some topics in the clinical management of regional anesthesia in children remain controversial. To evaluate and come to a consensus regarding some of these 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 pediatric regional anesthesia (PRA). METHODS: Representatives from both ASRA and ESRA comprised the joint committee practice advisory on PRA. Evidence-based recommendations were based on a systematic search of the literature. In cases where no literature was available, expert opinion was elicited. Experts selected controversial topics in PRA. RESULTS: The performance of PRA under general anesthesia or deep sedation is associated with acceptable safety and should be viewed as the standard of care (Evidence B2 and Evidence B3). Because of the difficulty interpreting a negative test dose, the use of test dosing should remain discretionary (Evidence B4). The use of either air-loss of resistance or saline-loss of resistance techniques is supported by expert opinion, but the literature supporting one technique over the other is sparse and controversial; when used appropriately, each technique may be safely used in children. There are no current evidence-based data that the use of RA increases the risk for acute compartment syndrome or delays its diagnosis in children. CONCLUSIONS: High-level evidence is not yet available for the topics evaluated, and most recommendations are based on Evidence B studies. The ESRA/ASRA recommendations intend to provide guidance for the safe practice of regional anesthesia in children.
BACKGROUND AND OBJECTIVES: Some topics in the clinical management of regional anesthesia in children remain controversial. To evaluate and come to a consensus regarding some of these 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 pediatric regional anesthesia (PRA). METHODS: Representatives from both ASRA and ESRA comprised the joint committee practice advisory on PRA. Evidence-based recommendations were based on a systematic search of the literature. In cases where no literature was available, expert opinion was elicited. Experts selected controversial topics in PRA. RESULTS: The performance of PRA under general anesthesia or deep sedation is associated with acceptable safety and should be viewed as the standard of care (Evidence B2 and Evidence B3). Because of the difficulty interpreting a negative test dose, the use of test dosing should remain discretionary (Evidence B4). The use of either air-loss of resistance or saline-loss of resistance techniques is supported by expert opinion, but the literature supporting one technique over the other is sparse and controversial; when used appropriately, each technique may be safely used in children. There are no current evidence-based data that the use of RA increases the risk for acute compartment syndrome or delays its diagnosis in children. CONCLUSIONS: High-level evidence is not yet available for the topics evaluated, and most recommendations are based on Evidence B studies. The ESRA/ASRA recommendations intend to provide guidance for the safe practice of regional anesthesia in children.
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