Contraindications

Absolute contraindications to regional anesthesia have no specificity in children and include infection at the puncture site, septicemia, and meningitis; bleeding disorders or a patient on anticoagulant therapy; true allergy to local anesthetics, which is rare even with aminoesters; and uncorrected hypovolemia (neuraxial blocks). ^{[72] [73] [98]} Major vertebral anomalies are contraindications to central block procedures, at least at the level of the anomalies. Minor to moderate lumbosacral spinal anomalies, including tethered cord syndrome; a functioning ventriculoperitoneal shunt; or mild seizure disorders are not contraindications for performing a central block.^[112] Degenerative axonal diseases have long been considered contraindications, but no data support the hypothesis that regional anesthesia can worsen the course (equally, no data support the hypothesis that regional anesthesia cannot worsen the course). Regional techniques must be avoided when there is a danger of compressive disorders in closed fascial compartments. For instance, in a patient with a plaster cast, the hemodynamic condition of the limb must be closely monitored. If the local conditions do not permit reliable monitoring by trained nurses, regional anesthesia must not be provided. Parental refusal and severe psychoneurotic disorders should be considered as contraindications. Specific contraindications are mentioned with the description of the relevant technique.