Neuraxial anaesthesia in paediatrics

Neuraxial anaesthesia is a valuable aid in the practice of paediatric anaesthesia. Spinal and epidural blockade are used as either the sole anaesthetic or as an adjunct to general anaesthesia, and often confer significant postoperative analgesia. Caudal epidural anaesthesia is used extensively for lower abdominal, urological and orthopaedic procedures in the setting of outpatient surgery. Lumbar and thoracic epidural infusions via a catheter can provide analgesia for chest and upper abdominal procedures. Thoracic paravertebral blocks provide analgesia equivalent to thoracic epidurals but with fewer side effects. Their use in thoracic surgery have helped reduce the incidence of chronic thoracotomy pain. Major complications related to neuraxial catheter placement are uncommon in paediatric anaesthesia, even though block placement is typically after the patient is anaesthetized to ensure immobility during puncture. Available evidence suggest that it is safe to place regional blocks in children during general anaesthesia. Ultrasound is an excellent imaging modality for identifying the dura mater as the dura appears highly echogenic on ultrasound scans. Ultrasound imaging help estimate the location and level of spinous interspaces and may be useful in children with obesity, prior surgical instrumentation or scoliosis. The use of the ultrasound for real-time visualization during paediatric neuraxial blocks provides an opportunity for observing final catheter position or confirming successful injection into the epidural space.