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The European Society of Regional Anaesthesia and Pain Therapy/American Society of Regional Anesthesia and Pain Medicine Recommendations on Local Anesthetics and Adjuvants Dosage in Pediatric Regional Anesthesia
  1. Santhanam Suresh, MD*,
  2. Claude Ecoffey, MD,
  3. Adrian Bosenberg, MB, ChB, FFA(SA),
  4. Per-Anne Lonnqvist, MD§,
  5. Gildasio S. de Oliveira Jr, MD, MSCi,
  6. Oscar de Leon Casasola, MD**,
  7. José de Andrés, MD, PhD†† and
  8. Giorgio Ivani, MD‡‡
  1. *Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, IL
  2. Pôle Anesthésie-SAMU-Urgences-Réanimations, Hôpital Pontchaillou, Université Rennes 1, Rennes, France
  3. University of Washington and Seattle Children's Hospital, Seattle, WA
  4. §Section of Anaesthesiology & Intensive Care, Department of Physiology & Pharmacology, Karolinska Institutet; and Paediatric Anaesthesia/PICU/ECMO Services, Karolinska University Hospital, Stockholm, Sweden
  5. Department of Anesthesiology at Rhode Island Hospital, Alpert School of Medicine, Brown University, Providence, RI
  6. **Department of Anesthesiology, State University of New York at Buffalo, Buffalo, NY
  7. ††Department of Anesthesia, Critical Care and Pain Medicine, University School of Medicine, General University Hospital, Valencia, Spain
  8. ‡‡Department of Anesthesiology, Regina Margherita Children's Hospital, Turin, Italy
  1. Address correspondence to: Santhanam Suresh, MD, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave, Chicago, IL 60611 (e-mail: ssuresh{at}luriechildrens.org).

Abstract

Background and Objectives Dosage of local anesthetics (LAs) used for regional anesthesia in children is not well determined. In order to evaluate and come to a consensus regarding some of these controversial topics, The European Society of Regional Anaesthesia and Pain Therapy (ESRA) and the American Society of Regional Anesthesia and Pain Medicine (ASRA) developed a Joint Committee Practice Advisory on Local Anesthetics and Adjuvants Dosage in Pediatric Regional Anesthesia.

Methods Representatives from both ASRA and ESRA composed the joint committee practice advisory. Evidence-based recommendations were based on a systematic search of the literature. In cases where no literature was available, expert opinion was elicited.

Results Spinal anesthesia with bupivacaine can be performed with a dose of 1 mg/kg for newborn and/or infant and a dose of 0.5 mg/kg in older children (>1 year of age). Tetracaine 0.5% is recommended for spinal anesthesia (dose, 0.07–0.13 mL/kg). Ultrasound-guided upper-extremity peripheral nerve blocks (eg, axillary, infraclavicular, interscalene, supraclavicular) in children can be performed successfully and safely using a recommended LA dose of bupivacaine or ropivacaine of 0.5 to 1.5 mg/kg. Dexmedetomidine can be used as an adjunct to prolong the duration of peripheral nerve blocks in children.

Conclusions High-level evidence is not yet available to guide dosage of LA used in regional blocks in children. The ASRA/ESRA recommendations intend to provide guidance in order to reduce the large variability of LA dosage currently observed in clinical practice.

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Footnotes

  • Identification of institution(s) where work is attributed: Ann & Robert H. Lurie Children's Hospital of Chicago Northwestern University, Chicago, IL; and Department of Anesthesiology at Rhode Island Hospital, Alpert School of Medicine, Brown University, Providence, RI.

    The authors declare no conflict of interest.

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