Current opinion in anaesthesiology
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Epidural blocks (caudal, lumbar or thoracic) are of common use in paediatric patients for special procedures such as open fundoplication as well as for postoperative analgesia. However, because neonates and infants have lower metabolic capacities and specific anatomy as compared to adults, the dose of local anaesthetics and the way of their administration need careful attention. ⋯ Pharmacokinetic studies allowing safer dosing, especially with ropivacaine have recently been published. New techniques of thoracic epidural with puncture at the lumbar level are also proposed. However, all these new techniques need to pass the test of time.
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In recent years there has been a renewed interest in regional anesthesia, particularly peripheral nerve blockade, in order not only to improve the patient's well being, but also to meet the requirements of modern orthopedic surgery. These requirements include appropriate conditions to perform early and efficient rehabilitation. ⋯ Early rehabilitation is currently a key point for the success of orthopedic surgery. The rapid development of peripheral nerve blockade gives the anesthesiologist the means to face this new challenge.
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Development of new drugs and special techniques, as well as changes in health care organization have markedly influenced the use of spinal block and its indications. The present review overviews recent developments in local anesthetic drugs, side effects and special techniques for intrathecal anesthesia. ⋯ The changes in health care organization observed during the past few years have forced us to change the indications for and clinical uses of intrathecal anesthesia techniques in accordance with the changing needs of surgery. The development of new drugs and special techniques for spinal anesthesia will further improve the clinical use of this old but trusted technique.
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The alpha(2)-adrenoceptor agonist clonidine is one of the most widely investigated substances in anaesthesia and pain therapy. Recently, numerous experimental and clinical studies have allowed a better understanding of its underlying mechanisms of action and interactions with other analgesic drugs. ⋯ During the past decade clonidine has been investigated as an adjuvant for general and regional anaesthesia and in the postoperative period. There is no doubt that clonidine improves analgesia after systemic, spinal or peripheral opioids, and prolongs the analgesic action of most local anaesthetics. The side-effects of usual doses of clonidine are predictable. Given the clinical experience of an increasing number of hospitals, clonidine should no longer be considered an experimental drug, but a useful addendum to the pharmacological armamentarium.