No abstract

Seven pediatric patients (aged 11-16 years) with chronic abdominal wall pain are presented who gained significant relief from a rectus sheath block (RSB). We describe the case histories and review the relevant literature for this technique. The etiology of the abdominal wall pain was considered to be abdominal cutaneous nerve entrapment, iatrogenic peripheral nerve injury, myofascial pain syndrome or was unknown. All patients showed significant initial improvement in pain and quality of life. Three patients required only the RSB to enable them to be pain-free and return to normal schooling and physical activities. Two children received complete relief for more than 1 year. In the majority of cases, the procedure was carried out under general anesthesia as a daycase procedure. Local anesthetic and steroids were used. This is the first report of the successful use of this technique in the chronic pain management setting in children.

The neonatal period represents a time of rapid growth and development. As a consequence, significant pharmacokinetic changes occur. In addition, pharmacodynamic changes, physiological inter-patient variability and pathological processes are factors to consider when trying to predict the action and disposition of drugs in the neonate. The problem is compounded by a relative paucity of research and data on many aspects of neonatal pharmacology. These issues pose significant challenges to the clinician to deliver safe and effective drug therapy to these vulnerable patients. Recent developments have attempted to redress this balance; many steps have been taken to increase the number of paediatric drug research programmes and the traditional challenges to research in children and neonates are being addressed by legislative authorities, pharmaceutical companies, clinicians and the academic community. These research issues are discussed along with the basic science of neonatal pharmacology and new developments in the past few years.

Institutional responses to a detailed multinational survey were used to characterise the range of current anaesthetic and surgical practices for paediatric scoliosis surgery. Questions addressed surgical practice, anaesthetic agents, blood-sparing techniques, neurophysiological monitoring used and recalled major complications. Twenty-seven (87%) institutions responded. The median number of cases of these institutions was 40 per year (range 5 to 700). Common practices included inhaled volatile anaesthetic maintenance (80%), omission of nitrous oxide (81%), intravenous remifentanil (88% [range 0.05 to 2.00 µg.kg-1 .min-1 ]), and double intravenous antiemetic agent prophylaxis (59%); multimodal analgesia with paracetamol and parenteral opioids, non-steroidal antiinflammartory drugs and epidural local anaesthetic or opioid infusion (UK) and intrathecal opioids and subanaesthetic doses of intravenous ketamine by infusion (Australia); use of cell-saver (81%), controlled hypotension (77%) and antifibrinolytic agents (74%) (intravenous aprotinin [59%] or tranexamic acid [44%]); and epidural somatosensory (92%), neurogenic motor-evoked (32%), compound motor action (31%) and transcranial motorevoked potential monitoring (54%), with routine wake-up test used infrequently (19%). Fifty-four neurological or cardiac adverse events or deaths were recalled. While institutional practices varied, common themes were identified. The information obtained may suggest new strategies to various centres and could be useful for planning multi-centre audits and trials.

Caudal blockade decreased the degree of arousal, as measured by BIS, in unstimulated children aged 2-5 years. No change in arousal was detected in infants.