Pediatric regional anesthesia: Complications and their management

• Published in: Techniques in regional anesthesia & pain management 1999, Vol.3 (3), p.138-145
• Main Author: Dalens, Bernard J.
• Format: Article
• Language: English
• ISSN: 1084-208X; 1558-4534
• DOI: 10.1016/S1084-208X(99)80034-2

Several types of complications can occur after a regional block procedure. Some are directly related to the performance of the block technique and include direct traumatic lesions to nerve structures; many of these complications can be avoided by using specifically designed needles. Other complications are the consequence of the administration of a local anesthetic to the child; they consist of local and systemic complications, including seizures, cardiac arrhythmias, and methemoglobinemia, although true allergic reactions to local anesthetics are rare. Because regional blocks are usually performed under general anesthesia in children, signs of central nervous system toxicity, such as seizures, may be concealed. Other complications result from poor selection, inappropriate environmental conditions concerning safety precautions, and inadequate monitoring of the patient (especially during the postoperative period); these complications are entirely avoidable. Two other groups of disorders are often reported as complications of regional anesthesia: (1) effects that were not anticipated by the anesthesiologist because of a lack of knowledge of all the consequences of the technique used and (2) complications attributed to a regional anesthetic but with no established, often even improbable, causal link with the regional technique. The overall morbidity of regional anesthesia in children is low and compares favorably with the overall morbidity of general anesthetic techniques used alone for similar surgical indications.