Cahiers d'anesthésiologie
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Cahiers d'anesthésiologie · Jan 1995
[Penile block. Block of ilio-inguinal and iliohypogastric nerves in children. Techniques, indications, advantages and adverse effects].
Peripheral blocks as penile blocks, ilio-inguinal ou ilio-hypogastric nerve blocks provide an useful alternative to caudal block in children, especially for penile surgery, herniotomy, and orchidopexy, frequently performed at this age. A precise anatomic location and a strict technique increase the success rate of these blocks. ⋯ Postoperative analgesia in ambulatory surgery is one of the best reasons to select these techniques. In addition they avoid prolonged motor effects observed with epidural anaesthesia.
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The placental transfer of local anaesthetics (LA) depends on maternal, placental and fetal factors. The assessment of effects of LA and epidural anaesthesia (EA) on the fetus is based on the monitoring of fetal heart rate (FHR) and the measurement of the fetal pH. Apgar score and neurobehavioral tests allow an evaluation of the neonatal effects of the drugs used. ⋯ Neurobehavioral scores are better after EA than after GA. For emergency caesarean section, the percentage of newborns with an Apgar score < 4 or necessitating a respiratory assistance is more important after GA than after EA. However, the perinatal mortality is not more important after GA than after EA.
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Postoperative pain after shoulder surgery is known to be intense and requires usually opioid administration. The recent use of regional anaesthesia for this type of surgery has contributed to the relief of acute postoperative pain occurring in the recovery room since the analgesic effects of block persist for several hours after surgery depending upon the selected drug. Moreover, the development of less invasive surgery (arthroscopy) and experience with regional blocks have permitted to perform minor shoulder surgery on an outpatient basis. ⋯ However, for more invasive surgery, regional anaesthesia should be associated to a light general anaesthesia as well as the insertion of a supraclavicular catheter for postoperative analgesia. A diaphragmatic paresis secondary to a blockade of the phrenic nerve is constant radiologically after interscalenic block but remains symptomless. However, in case of severe preoperative chronic respiratory insufficiency, decompensation may occur rapidly after performance of the interscalenic block.