Perioperative Analgesic Management of Newborn Bladder Exstrophy Repair Using a Directly Placed Tunneled Epidural Catheter with 0.1% Ropivacaine.

Effective multimodal analgesia and sedation reduce the postoperative morbidity and mortality associated with newborn bladder exstrophy repair. Epidural analgesia is safe and effective for major surgery in neonates and infants, reducing the need for muscle relaxants, opioids, and ventilator support postoperatively. The risk of epidural catheter colonization typically dictates removal after 3 to 5 days. Tunneling the catheter subcutaneously reduces the risk of colonization, providing prolonged analgesia for patients requiring an extended immobilization to prevent compromise of the repair. In this report, we describe the postoperative analgesic management of an infant undergoing bladder exstrophy repair using a directly placed tunneled epidural catheter with ropivacaine 0.1% infusion. Because of the prolonged infusion, we also monitored plasma ropivacaine levels to preclude systemic toxicity from local anesthetic overdose.

Continuous intraoperative TEE monitoring for a child with Fontan pathway undergoing post spinal fusion.

The following case report describes a very challenging surgical case where the use of intraoperative, continuous TEE monitoring in the prone position was crucial for the anesthetic management (diagnosis and treatment) of a patient with single ventricle physiology. The use of TEE monitoring enabled the anesthesia team to continuously assess hemodynamic stability and respond immediately to hypotension and bradycardia in our patient, thereby providing optimal anesthetic care of the intraoperative spinal fusion patient with Fontan physiology.

Comparison of femoral nerve block and fascia iliaca block for analgesia following reconstructive knee surgery in adolescents.

STUDY OBJECTIVE: To compare the femoral nerve block with the fascia iliaca block for postoperative analgesia in adolescents undergoing reconstructive knee surgery. DESIGN: Randomized, single-blinded study. SETTING: Full-service pediatric medical center. PATIENTS: 23 ASA physical status I and II patients, aged 8 to 16 years, undergoing anterior cruciate ligament (ACL) repair. INTERVENTIONS: Patients received either fascia iliaca or femoral nerve block prior to reconstructive surgery. MEASUREMENTS: Pain scores by visual analog scale (VAS; 0-10) and morphine use were routinely recorded through to discharge from the hospital. Pain scores were assessed on days 1 and 2 at home post-discharge. MAIN RESULTS: There was no difference between the femoral nerve block and the fascia iliaca nerve block in VAS pain scores or postoperative morphine consumption. CONCLUSION: Either the femoral nerve block or the fascia iliaca block, followed by patient-controlled analgesia with morphine, provides efficacious analgesia for adolescents undergoing ACL reconstruction.

Intrathecal local anesthetic infusion as a treatment for complex regional pain syndrome in a child.

Diagnosis and treatment of complex regional pain syndrome in children is one of the most challenging clinical pain problems encountered in the chronic pain setting. Despite the intense and debilitating nature of the pain, referral to appropriate specialists often comes too late, thereby prolonging an already arduous (and controversial) course of treatment and risking long-term disability. On the contrary, full recovery can be expected with early diagnosis and prompt treatment. The following case study describes a novel and successful use of intrathecal catheter administration of ropivacaine in a child with early, rapidly progressing, and debilitating complex regional pain syndrome.

Bupivacaine induces transient neurological symptoms after subarachnoid block.

Bupivacaine is a long-acting amide local anesthetic that was introduced to clinical practice in the early 1980s. Since then it has been extensively used for both peripheral blocks as well as neuraxial blockade in concentrations varying from 0.125% to 0.75%. Despite the relatively narrow safety margin, bupivacaine has become the most frequently used local anesthetic in obstetric anesthesia. It is 95% metabolized in the liver and 5% excreted unchanged in urine. Bupivacaine cardiotoxicity is related to the total dose rather than to the concentration of bupivacaine administered. It produces a dose-dependent delay in the transmission of impulses through the cardiac conduction system by blocking sodium channels. Transient neurologic symptoms (TNS) defined as bilateral symmetrical pain in the lower back and buttocks with radiation to both lower extremities after 5% lidocaine spinal anesthetic was first described by Schneider in 1993. Several studies have failed to show TNS after spinal anesthesia using bupivacaine 0.5% or 0.75%. In the literature there is only 1 case report of TNS after spinal anesthesia using bupivacaine and morphine. The following report describes a case of TNS following spinal anesthesia with bupivacaine 0.75%.