Cahiers d'anesthésiologie
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Regional anaesthesia is more and more popular in pediatrics. Many arguments plead for its use. ⋯ So is the quality of intra- and postoperative analgesia. In addition, the few number of complications is also an advantage of regional blocks in children.
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This article will briefly review the techniques of epidural anaesthesia via lumbar and sacral routes, as well as the indications and contraindications of the techniques. Guidelines for per- and postoperative use of epidural anaesthesia are provided.
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Wound infiltration with a local anaesthetic may be used either to provide anaesthesia for superficial surgery or for postoperative pain relief. In the latter situation, its efficacy is real but remains moderate and usually requires a combination with other analgesics. Ilio-iguinal and ilio-hypogastric block has been shown to have an analgesic efficacy close to that obtained with a wound infiltration but the duration of analgesia may be longer. These blocks remain unfrequently used in adults.
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The placental transfer of local anaesthetics (LA) depends on maternal, placental and fetal factors. The assessment of effects of LA and epidural anaesthesia (EA) on the fetus is based on the monitoring of fetal heart rate (FHR) and the measurement of the fetal pH. Apgar score and neurobehavioral tests allow an evaluation of the neonatal effects of the drugs used. ⋯ Neurobehavioral scores are better after EA than after GA. For emergency caesarean section, the percentage of newborns with an Apgar score < 4 or necessitating a respiratory assistance is more important after GA than after EA. However, the perinatal mortality is not more important after GA than after EA.