A review of pediatric regional anesthesia practice during a 17-year period in a single institution

Abstract

Background: There is anecdotal evidence of changes in pediatric regional anesthesia (RA) practice. We performed a retrospective review of prospective data on pediatric RA over 17 years in our institution.

Methods: Data were collected from an electronic database for every anesthetic performed between 1989 and 2005. Type of RA, if any, and age of the patient were noted. Patients were divided into two groups: <or=4 years (younger group) and 5 years or older (older group).

Results: A total of 51 408 anesthetics were performed; 23 609 (46%) in the younger group. A total of 10,929 RA were performed. In the younger group, RA increased from 9.5% to 27.6% (P<0.001). Neuraxial blocks decreased from 100% to 59.7% of RA. Caudals decreased in the late 1990s from 70% to 22% of RA and epidurals have decreased from 22% to 11% of RA since 2002. Neonatal spinals were introduced in 1990 and now reach 30% of RA. Peripheral blocks have increased up to 37% of RA since 1994. In the older group, RA increased from 9.2% to 23.3% (P<0.001), less than in the younger (P<0.01). Neuraxial blocks have decreased from 97% to 24.9% of RA (P<0.001), more obviously than in the younger group (P<0.001). Peripheral blocks emerged in 1994, outnumbering neuraxial blocks as early as 1995 and now account for 75% of RA. This increase is significantly more pronounced than in the younger group (P<0.001). In both groups, peripheral blocks were distributed among plexus blocks (30%) and compartment/peripheral nerve blocks (70%). In the last 5 years, a perineural catheter was placed in 12.9% of peripheral blocks to ensure continuous postoperative analgesia.

Conclusions: In our hospital, there has been a dramatic increase in RA, mainly from 1989 to 1995. The most remarkable events in the last decade were: (i) the change in practice from neuraxial to peripheral blocks and (ii) the emergence of continuous postoperative analgesia via perineural catheters.