Pediatrik Rejyonal Anestezi
Özet
Pediatrik rejyonal anestezi, modern pediatrik anestezi uygulamalarının vazgeçilmez bir parçası haline gelmiştir. Bu teknik, özellikle opioid kullanımının neden olduğu mide bulantısı ve kusma gibi yan etkilerden kaçınarak opioid içermeyen bir süreç yönetimine olanak tanır. Ayrıca, ameliyat sonrası kalıcı ağrı (PPSP) insidansını azaltması ve genel anestezik ajan gereksinimini düşürerek deliryum riskini ve nörotoksisite ihtimalini en aza indirmesi önemli avantajlarındandır. Küçük çocuklarda ağrı eşiğinin düşük olması ve inen inhibitör yolakların yetersiz gelişimi nedeniyle etkili rejyonal analjezi kritik öneme sahiptir. Yapılan geniş çaplı araştırmalar bu yöntemlerin düşük komplikasyon oranlarına sahip olduğunu kanıtlamaktadır. Günümüzde ultrason rehberliği (USR) kullanımı giderek daha fazla önerilmekte; rektus kılıfı, femoral sinir ve siyatik sinir blokları gibi birçok teknikte damarsal yapıların tespiti ve güvenli uygulama için tercih edilmektedir. Çalışmalar, USR'nin tüm rejyonal tekniklerdeki kullanım oranının %23 seviyelerinde olduğunu ve bu yöntemin doğruluğu artırdığını vurgulamaktadır.
Pediatric regional anesthesia has become an integral part of modern pediatric anesthesia practice. This technique allows for an opioid-free anesthesia management, avoiding problematic side effects such as nausea and vomiting. Additionally, it offers significant advantages such as reducing the incidence of persistent post-surgical pain (PPSP) and minimizing the risk of delirium and potential neurotoxicity by decreasing the requirement for general anesthetic agents. Effective regional analgesia is critical in young children due to their lower pain thresholds and underdeveloped descending inhibitory pathways. Large-scale studies demonstrate that these methods have low complication rates. Today, the use of ultrasound guidance (USG) is increasingly recommended and preferred for identifying vascular structures and ensuring safe application in many techniques, such as rectus sheath, femoral nerve, and sciatic nerve blocks. Research highlights that the usage rate of USG in all regional techniques is around 23% and emphasizes that this method enhances accuracy.
Referanslar
Suresh S, Ecoffey C, Bosenberg A, Lonnqvist PA, De Oliveira GS, de Leon Casasola O, De Andrés J, Ivani G. The European Society of Regional Anaesthesia and Pain Therapy/American Society of Regional Anesthesia and Pain Medicine recommendations on local anesthet- ics and adjuvants dosage in pediatric regional anesthesia. Reg Anesth Pain Med. 2018 Feb 1;43(2):211–6.
Walker BJ, Long JB, Sathyamoorthy M, et al. Complications in pediatric regional anesthesia: an analysis of more than 100,000 blocks from the Pediatric Regional Anesthesia Network. Anesthesiology. 2018;129:721–32.
Dadure C, Veyckemans F, Bringuier S, Habre W. Epidemiology of regional anesthesia in children: lessons learned from the European Multi-Institutional Study APRICOT. Paediatr Anaesth. 2019;29:1128–35.
Giaufre 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;83:904–12.
Ecoffey C, Lacroix F, Giaufre E, et al. Epidemiology and morbidity of regional anesthesia in children: a follow-up one year prospective survey of the French-Language Society of Pediatric Anaesthesiologists. Pediatr Anesth. 2010;20:1061–9.
Willschke H, Kettner S. Pediatric regional anesthesia: abdominal wall blocks. Pediatr Anesth. 2012;22:82–92.
Taddio A, Katz J, Ilersich AL, Koren G. Effect of neonatal circumcision on pain response dur- ing subsequent routine vaccination. Lancet. 1997;349:599–603.
Willschke H, Bosenberg A, Marhofer P, Willschke J, Schwindt J, Weintraud M, et al. Epidural catheter placement in neonates: sonoanatomy and feasibility of ultrasonographic guidance in term and preterm neonates. Reg Anesth Pain Med. 2007;32:34–40.
Ahiskalioglu A, Yayik AM, Ahiskalioglu EO, Ekinci M, Gölboyu BE, Celik EC, et al. Ultrasound-guided versus conventional injection for caudal block in children: a prospective randomized clinical study. J Clin Anesth. 2018;44:91–6.
Ponde VC, Bedekar VV, Desai AP, Puranik KA. Does ultrasound guidance add accuracy to continuous caudal-epidural catheter placements in neonates and infants? Paediatr Anaesth. 2017;27:1010–4.
Busoni P, Sarti A. Sacral intervertebral epidural block. Anesthesiology. 1987;67:993–5.
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;117:1401–7.
Kendigelen P, Tutuncu AC, Emre S, Altindas F, Kaya G. Pudendal versus caudal block in chil- dren undergoing hypospadias surgery: a randomized controlled trial. Reg Anesth Pain Med. 2016;41:610–5.
Zhu C, Wei R, Tong Y, Liu J, Song Z, Zhang S. Analgesic efficacy and impact of caudal block on surgical complications of hypospadias repair: a systematic review and meta-analysis. Reg Anesth Pain Med. 2019 Feb 1;44(2):259–67.
Parras T, Blanco R. Bloqueo pudendo ecoguiado/Ultrasond guided pudendal block. Cir Mayor Ambul. 2013;18:31–5.
Rofaeel A, Peng P, Louis I, Chan V. Feasibility of real-time ultrasound for pudendal nerve block in patients with chronic perineal pain. Reg Anesth Pain Med. 2008;33:139–45.
Gaudet-Ferrand I, De La Arena P, Bringuier S, Raux O, Hertz L, Kalfa N, Sola C, Dadure
C. Ultrasound-guided pudendal nerve block in children: a new technique of ultrasound-guided transperineal approach. Pediat Anesth. 2018 Jan;28(1):53–8.
