Epidemiology of regional anesthesia in children: Lessons learned from the European Multi-Institutional Study APRICOT.
Adolescent
Anesthesia, Conduction
/ adverse effects
Anesthesia, General
/ statistics & numerical data
Anesthesia, Local
/ statistics & numerical data
Anesthetics, Local
/ therapeutic use
Child
Child, Preschool
Databases, Factual
Europe
/ epidemiology
Humans
Infant
Infant, Newborn
Nerve Block
/ statistics & numerical data
Europe
children
regional anesthesia
Journal
Paediatric anaesthesia
ISSN: 1460-9592
Titre abrégé: Paediatr Anaesth
Pays: France
ID NLM: 9206575
Informations de publication
Date de publication:
11 2019
11 2019
Historique:
received:
14
05
2019
revised:
29
08
2019
accepted:
02
09
2019
pubmed:
6
9
2019
medline:
24
7
2020
entrez:
6
9
2019
Statut:
ppublish
Résumé
Recently, the European prospective observational multicenter cohort study, APRICOT, reported anesthesia techniques and complications in more than 31 000 pediatric procedures. The main objective of this study was to analyze the current practice in regional anesthesia in the 33 countries that participated to APRICOT. Data on regional anesthesia techniques were extracted from the database of APRICOT (261 centers across 33 European countries). All children, aged from birth to 16 years old, were eligible for inclusion during a 2-week period. Type of regional anesthesia, whether used awake or with sedation or general anesthesia, techniques of guidance, and the drugs administered were analyzed. Regional anesthesia was used in 4377 pediatric surgical procedures. The large majority was performed under general anesthesia with central blocks and truncal blocks, representing, respectively, 42.6% and 41.8% of performed techniques. Caudal blocks represented 76.9% of all central blocks. The penile and ilioinguinal/iliohypogastric blocks were the most commonly performed truncal blocks. Anesthetists used mainly anatomical landmarks; ultrasound guidance was applied in only 23.8% of cases. A wide variability of practices was observed in terms of regional anesthesia techniques and local anesthetics among the participating European countries. No serious complications were reported. These data show a large predominance of central and truncal blocks in APRICOT study. Ultrasound guidance was mainly used for peripheral nerve blocks while central blocks were performed using landmark techniques.
Sections du résumé
BACKGROUND
Recently, the European prospective observational multicenter cohort study, APRICOT, reported anesthesia techniques and complications in more than 31 000 pediatric procedures. The main objective of this study was to analyze the current practice in regional anesthesia in the 33 countries that participated to APRICOT.
METHODS
Data on regional anesthesia techniques were extracted from the database of APRICOT (261 centers across 33 European countries). All children, aged from birth to 16 years old, were eligible for inclusion during a 2-week period. Type of regional anesthesia, whether used awake or with sedation or general anesthesia, techniques of guidance, and the drugs administered were analyzed.
RESULTS
Regional anesthesia was used in 4377 pediatric surgical procedures. The large majority was performed under general anesthesia with central blocks and truncal blocks, representing, respectively, 42.6% and 41.8% of performed techniques. Caudal blocks represented 76.9% of all central blocks. The penile and ilioinguinal/iliohypogastric blocks were the most commonly performed truncal blocks. Anesthetists used mainly anatomical landmarks; ultrasound guidance was applied in only 23.8% of cases. A wide variability of practices was observed in terms of regional anesthesia techniques and local anesthetics among the participating European countries. No serious complications were reported.
CONCLUSION
These data show a large predominance of central and truncal blocks in APRICOT study. Ultrasound guidance was mainly used for peripheral nerve blocks while central blocks were performed using landmark techniques.
Substances chimiques
Anesthetics, Local
0
Types de publication
Journal Article
Multicenter Study
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1128-1135Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2019 John Wiley & Sons Ltd.
Références
Polaner DM, Taenzer AH, Walker BJ, et al. Pediatric Regional Anesthesia Network (PRAN): a multi-institutional study of the use and incidence of complications of pediatric regional anesthesia. Anesth Analg. 2012;115:1353-1364.
Ecoffey C, Lacroix F, Giaufre E, Orliaguet G, Courrèges P, ADARPEF. Epidemiology and morbidity of regional anesthésia in children: a follow-up one-year prospective survey of the French-Language Society of Paediatric Anaesthesiologists (ADARPEF). Pediatr Anesth. 2010;20:1061-1069.
Walker BJ, Long JB, Sathyamoorthy M, et al. Pediatric regional anesthesia network investigators. Complications in pediatric regional anesthesia: an analysis of more than 100,000 blocks from the pediatric regional anesthesia network. Anesthesiology. 2018;129:721-732.
Giaufré E, Dalens B, Gombert A. Epidemiology and morbidity of regional anesthesia in children: a one-year prospective survey of the French-Language Society of Pediatric Anesthesiologists. Anesth Analg. 1996;83:904-912.
Habre W, Disma N, Virag K, et al. Incidence of severe critical events in paediatric anaesthesia (APRICOT): a prospective multicentre observational study in 261 hospitals in Europe. Lancet Respir Med. 2017;5:412-425.
Suresh S, De Oliveira GS. Local anaesthetic dosage of peripheral nerve blocks in children: analysis of 40 121 blocks from the Pediatric Regional Anesthesia Network database. Br J Anaesth. 2018;120:317-322.
Abdellatif AA. Ultrasound-guided ilioinguinal/iliohypogastric nerve blocks versus caudal block for postoperative analgesia in children undergoing unilateral groin surgery. Saudi J Anaesth. 2012;6(4):367-372.
Bryskin RB, Londergan B, Wheatley R, et al. Transversus abdominis plane block versus caudal epidural for lower abdominal surgery in children: a double-blinded randomized controlled trial. Anesth Analg. 2015;121(2):471-478.
Lonnqvist PA. Is ultrasound guidance mandatory when performing paediatric regional anaesthesia ? Curr Opin Anaesthesiol. 2010;23:337-341.
Kundra P, Yuvaraj K, Agrawal K, Krishnappa S, Kumar LT. Surgical outcome in children undergoing hypospadias repair under caudal epidural vs penile block. Pediatr Anesth. 2012;22:707-712.
O'Sullivan MJ, Mislovic B, Alexander E. Dorsal penile nerve block for male pediatric circumcision-randomized comparison of ultrasound-guided vs anatomical landmark technique. Pediatr Anesth. 2011;21:1214-1218.
Teunkens A, Van de Velde M, Vermeulen K, et al. Dorsal penile nerve block for circumcision in pediatric patients: a prospective, observer-blinded, randomized controlled clinical trial for the comparison of ultrasound-guided vs landmark technique. Pediatr Anesth. 2018;28:703-709.
Naja ZM, Ziade FM, Kamel R, El-Kayali S, Daoud N, El-Rajab MA. The effectiveness of pudendal nerve block versus caudal block anesthesia for hypospadias in children. Anesth Analg. 2013;117:1401-1407.
Kendigelen P, Tutuncu AC, Emre S, et al. Pudendal versus caudal block in children undergoing hypospadias surgery: a randomized controlled trial. Reg Anesth Pain Med. 2016;41:610-615.
Hecht S, Piñeda J, Bayne A. Ultrasound-guided pudendal block is a viable alternative to caudal block for hypospadias surgery: a single surgeon pilot study. Urology. 2017;113:192-196.
Saavedra-Belaunde JA, Soto-Aviles O, Jorge J, Escudero K, Vazquez-Cruz M, Perez-Brayfield M. Can regional anesthesia have an effect on surgical outcomes in patients undergoing distal hypospadia surgery? J Pediatr Urol. 2017;13:45.e1-45.e4.
Taicher BM, Routh JC, Eck JB, Ross SS, Wiener JS, Ross AK. The association between caudal anesthesia and increased risk of postoperative surgical complications in boys undergoing hypospadias repair. Pediatr Anesth. 2017;27:688-694.
Guay J, Suresh S, Kopp S. The use of ultrasound guidance for perioperative neuraxial and peripheral nerve blocks in children: a cochrane review. Anesth Analg. 2017;124:948-958.
Tsui BC, Pillay JJ. Evidence-based medicine: assessment of ultrasound imaging for regional anesthesia in infants, children, and adolescents. Reg Anesth Pain Med. 2010;35:S47-S54.
Eypasch E, Lefering R, Troidl H. Probability of adverse events that have not yet occurred: a statistical reminder. BMJ. 1995;311:619-620.