SELECTION OF MATERIALS, TECHNIQUES, AND AGENTS
Selection of a Suitable Block Procedure
Regional block procedures are mostly used for relieving pain and
improving the comfort of the patient. Their advantages and disadvantages must be
compared with
other available techniques of analgesia (e.g., parenteral opioids). Because regional
techniques are usually performed under general anesthesia, the anesthesiologist must
carefully check the potential risks of available techniques and restrict the choice
to a procedure that can be done without the patient's cooperation; that is virtually
free of complications, even if less effective; and that has been evaluated for reliability
and safety in a large series of pediatric patients. Several factors should be considered
for the chosen technique: the abolition of pain in the operative field and all the
areas involved in the surgery (e.g., site of tourniquet placement, sites where skin
or bone grafts are to be taken); the adequacy of the duration of the sensory block
with the expected duration of postoperative pain; the physical condition of the patient;
the local conditions at the site of puncture; the suitability of the position required
for performing the block according to the lesions and physical condition of the child;
the similar importance of anesthetic and surgical techniques (under normal conditions,
central blocks should be avoided for minor surgery); and the experience of the anesthesiologist.
[72]
[98]
The possibility
that technical difficulties may be encountered in attempting to locate a nerve trunk
or a spinal space must be envisaged preoperatively with the patient's family and
alternate procedures that could be used in such an event should be clearly detailed.
When confronted with a technical failure, the anesthesiologist should not make a
second attempt without verifying the position of the patient and the landmarks used.
In any case, it is unreasonable to attempt to perform the same procedure more than
three times in the same patient.
