[The safety of peridural anesthesia realized in general anesthesia]

[Perioperative analgesia with continuous peripheral nerve blocks in children]

Recently, regional anaesthesia in children has generated increasing interest. But single injection techniques have a limited duration of postoperative analgesia. Then, continuous peripheral nerve blocks have taken an important position in the anaesthetic arsenal, allowing an effective, safe and prolonged postoperative pain management. As adults, indications for continuous peripheral nerve blocks depend on the analysis of individual benefits/risks ratio. Main indications are intense postoperative pain surgical procedures, with or without postoperative rehabilitation, and complex regional pain syndrome. Contraindications to these procedures are rather similar to those in adults, plus parental and/or children refusal. Continuous peripheral nerve blocks are usually performed under general anaesthesia or sedation in children, and require appropriate equipment in order to decrease the risk of nerve injury. New techniques, such as transcutaneous nerve stimulation or ultrasound guidance, appeared to facilitate nerve and plexus approach identification in paediatric patients. Nevertheless, continuous peripheral nerve block may theoretically mask a compartment syndrome after trauma surgical procedures. Finally, ropivacaine appears to be the most appropriate drug for continuous peripheral nerve blocks in children, requiring low flow rates and concentrations of local anaesthetic. These techniques may facilitate early ambulation by an improved pain management or even postoperative analgesia at home with disposable pumps. One might infer from the current review that excellent pain relief coupled with a reduction of side effects would contribute to improve the quality of life and to decrease the frequency of disabling behavioural modifications in children, sometimes psychologically injured by hospital stay and postoperative pain.

[Syringomyelia discovered in the course of peridural anesthesia]

Neurological symptoms after epidural anaesthesia suggest complications due to anaesthetic procedure. We report the case of a child who underwent perineal surgery in a gynaecological position under general and epidural anaesthesia, who experienced the day after surgery hypoesthesia of the whole left lower limb without any motor deficit. Magnetic resonance imaging excluded spinal compression, but revealed syringomyelic cavity extending from T9 to T11. Electromyogram evaluation was normal. Clinical signs completely vanished within 24 hours. This case emphasizes that the apparition of neurological signs after central nerve blocks is not only a complication of regional anaesthesia, but may reveal unknown neuropathy or result from surgical position or surgical procedure. Meticulous neurological examination, magnetic resonance imaging and electromyogram are immediately required.