Chronic pain and regional anesthesia in children

• Published in: Archives de pédiatrie : organe officiel de la Société française de pédiatrie 2013-10, Vol.20 (10), p.1149-1157
• Main Authors: Dadure, C, Marec, P, Veyckemans, F, Beloeil, H
• Format: Article
• Language: fre
• Subjects: Anesthesia, Conduction; Blood Patch, Epidural; Child; Chronic Pain - therapy; Headache Disorders - therapy; Humans; Phantom Limb - therapy; Reflex Sympathetic Dystrophy - therapy
• ISSN: 1769-664X
• DOI: 10.1016/j.arcped.2013.07.004

Chronic pain is usually underestimated in children, due to lack of knowledge and its specific signs. In addition to suffering, chronic pain causes a physical, psychological, emotional, social, and financial burden for the child and his family. Practitioners may find themselves in a situation of failure with depletion of medical resources. Some types of chronic pain are refractory to conventional systemic treatment and may require the use of regional anesthesia. Cancer pain is common in children and its medical management is sometimes insufficient. It is accessible to neuroaxial or peripheral techniques of regional anesthesia if it is limited to an area accessible to one of these techniques and no contraindications (e.g., thrombopenia) are present. Complex regional pain syndrome 1 is not rare in children and adolescents, but it often goes undiagnosed. Regional anesthesia may contribute to the treatment of complex regional pain syndrome 1, mainly in case of recurrence, because it provides rapid effective analgesia and allows rapid implementation of intensive physiotherapy. These techniques have also shown interest in phantom limb pain after limb amputation, but they remain controversial for erythromelalgia pain or chronic abdominopelvic pain. Finally, the treatment of postdural puncture headache due to cerebrospinal fluid leak can be treated by performing an epidural injection of the patient's blood, called a blood-patch. Finally, the management of children with chronic pain should be multidisciplinary (pediatrician, physiotherapist, psychologist, surgeon, anesthesiologist) to support the child and her problem in its entirety.