Regional anesthetics: traditions and innovations

  • A. I. Haas National Pirogov Memorial Medical University, Vinnytsya
  • D. O. Koval National Pirogov Memorial Medical University, Vinnytsya
  • O. O. Haas National Pirogov Memorial Medical University, Vinnytsya
Keywords: regional anesthesia, spinal anesthesia, unipolar spinal anesthesia, epidural anesthesia, caudal anesthesia, paravertebral block, TAP-block, PecS-II block, ilioinguinal/iliohypogastric block, children


The wide implementation of different regional anesthesia techniques is also actual in pediatric anesthesiology. Using modern methods of regional anesthesia (RA) and modern local anesthetics is a new level in development of pediatric anesthesiology. This article is about advantages of regional pediatric anesthesia in intra- and post-surgery pain management and analgesia. We analyse the techniques of spinal and epidural anesthesia, as well as their varieties such as unipolar spinal block and caudal anesthesia, compare their advantages and disadvantages. Some more techniques such as paravertebral block, TAP-block are considered as an alternative to epidural anesthesia. Methods and possibilities of ilioinguinal, iliohypogastric and TAP-blocks are also mentioned here. The use of the above-mentioned methods allows to reduce the use of narcotic analgesics and hypnotics and, as a consequence, reduces their systemic effects on the child’s body. These methods are safer for use, since they allow you to plan a safe anesthetic for each child and minimize complications.


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Грегори Дж.А. Анестезия в педиатрии / Дж.А. Грегори. – М.: Медицина, 2003. – 1178 c.

Puncuh F., Lampugnani E., Kokki H. Use of spinal anesthesia in pediatric patients: A single centre experience with 1132 cases // Pediatr. Anesth. – 2004. – № 14. – Р. 564–567.

Gupta A., Saha U., Sinha S.K., Gupta N. Subarachanoid block (SAB) versus general anaesthesia (GA) in children undergoing surgeries below umbilicus // J. Anaesthesiol. Clin. Pharmacol. – 2008. – № 24. – Р. 425–428.

Kachko L., Simhi E., Tzeitlin E., Efrat R., Tarabikin E., Peled E. et al. Spinal anesthesia in neonates and infants – a single-center experience of 505 cases // Paediatr. Anaesth. – 2007. – № 17. – Р. 647–653.

Williams R.K., Adams D.C., Aladjem E.V., Kreutz J.M., Sartorelli K.H., Vane D.W. et al. The safety and efficacy of spinal anesthesia for surgery in infants: The Vermont Infant Spinal Registry // Anesth. Analg. – 2006. – № 102. – Р. 67–71.

Williams R.K., McBride W.J., Abajian J.C. Combined spinal and epidural anesthesia for major abdominal surgery in infants // Can. J. Anaesth. – 1997. – № 44. – Р. 511–514.

Aronsson D.D., Gemery J.M., Abajian J.C. Spinal anesthesia for spine and lower extremity surgery in infants // J. Pediatr. Orthop. – 1996. – № 16. – Р. 259–263.

Calvert D.G. Direct spinal anesthesia for repair of myelomeningocele // Br. Med. J. – 1996. – № 2. – Р. 86–87.

Viscomi C.M., Abajian J.C., Wald S.L., Rathmell J.P., Wilson J.T. Spinal anesthesia for repair of meningomyelocele in neonates // Anesth. Analg. – 1995. – № 81. – Р. 492–495.

Dallens B.J., Khandwala R.S., Tanguy A. Staged segmental scoliosis surgery during regional anesthesia in high risk patients: A report of six cases // Anesth. Analg. – 1993. – № 76. – Р. 434–439.

Gingrich Bk. Spinal anesthesia for a former preterm infant undergoing upper abdominal surgery // Anesthesiology. – 1993. – № 79. – Р. 189–190.

O’Higashi T., Shirakami G., Sasai S., Shinomura T., Kato S., Tomoda K. Spinal anesthesia for patients with progressive muscular dystrophy // Masui. – 1995. – № 44. – Р. 723–728.

Tobias J.D. Anesthetic care for the child of Morquio Syndrome: General versus regional anesthesia // J. Clin. Anesth. – 1999. – № 11. – Р. 242–6.

Arora M.K., Nagaraja G., Lakhe S.T. Combined spinal-epidural anesthetic for a child with Freeman-Sheldon syndrome with difficult airway // Anesth. Analg. – 2006. – № 103. – Р. 1624.

Ecoffey C., Lacroix F., Giaufré E., Orliaguet G., Courrèges P. Association des Anesthésistes Réanimateurs Pédiatriques d’Expression Française (ADARPEF) Epidemilogy and morbidity of regional anesthesia in children: A follow-up one-year prospective survey of the FrenchLanguage Society of Pediatric Anesthesiologists (ADARPEF) // Paediatr. Anaesth. – 2010. – № 20. – Р. 1061–1069.

Krane E.J., Harberkern C.M., Jacobson L.E. Postoperative apnea, bradycardia and oxygen desaturation in formerly premature infants: Prospective comparison of spinal and general anesthesia // Anesth. Analg. – 1995. – № 80. – Р. 7–13.

Пащук А.Ю. Регионарное обезболивание. – М.: Медицина, 1987. – 155 с.

Регионарная анестезия: Пер. с англ. под ред. Зильбера А.П., Мальцева В.В. / Рамфел Д.П., Нил Д.М., Вискоуми К.М. – М.: МЕДпресс-информ, 2008. – 272 с.

Duniec L., Nowakowski P., Kosson D., Łazowski T. Anatomical landmarks based assessment of intravertebral space level for lumbar puncture is misleading in more than 30 % // Anaesthesiol. Intensive Ther. – 2013 Jan-Mar. – № 45(1). – Р. 1–6.

Курек, В. В., Детская анестезиология, реаниматология и интенсивная терапия [Текст] : руководство / В. В. Курек, А. Е. Кулагин. – М. : Медицинское информационное агентство, 2011. – 992 с.

Анестезиология и интенсивнаятерапия в педиатрии [Текст] : учебник / Э. Г. Агавелян [и др.] ; ред.: В. А. Михельсон, В. А. Гребенников. – 3-е изд., перераб. и доп. – М. : МЕДпресс-информ, 2009. – 512 с. : ил.

Оксфордский справочник по анестезиологии: Пер. с англ. под ред. проф. Евдокимова Е.А. / Олман К., Уилсон А.– М.: Бином, 2009.– 768 с.

Van Schoor A.N., Bosman M.C., Bosenberg A.T. Descriptive study of the differences in the level of the conus medullaris in four different age groups // Clin. Anat. – 2015 Feb 2. – Doi: 10.1002/ ca.22505.

Регионарная анестезия: Самое необходимое в анестезиологии / Д.П.Рафмелл, Д.М. Нил, К.М. Вискоуми ; Пер. с англ. ; Под общ. ред. А.П. Зильбера, В.В. Мальцева. – М. : МЕДпресс-информ, 2007. – С. 237–246.

Gray H.T. A study of subarachnoid block in children and infants // Lancet. – 1909. – № 2. – Р. 913–917.

Kokki H. Spinal blocks // Paediatr. Anaesth. – 2012. – № 22. – Р. 56–64.

Abajian J.C., Mellish R.W., Browne A.F., Perkins F.M., Lambert D.H., Mazuzan J.E. Jr. Spinal anesthesia for surgery in the highrisk infant // Anesth. Analg. – 1984. – № 6. – Р. 359–362.

Dohi S., Seino H. Spinal anesthesia in premature infants: Dosage and effects of sympathectomy // Anesthesiology. – 1986. – № 65. – Р. 559–561.

Kokki H., Heikkinen M., Ahonen R. Recovery after paediatric day case herniotomy performed under spinal anaesthesia // Pediatr. Anesth. – 2000. – № 10. – Р. 413–417.

Singh R., Batra Y.K., Bharti N., Panda N.B. Comparison of propofol versus propofol-ketamine combination for sedation during spinal anesthesia in children: Randomized clinical trial of efficacy and safety // Paediatr. Anaesth. – 2010. – № 20. – Р. 439–444.

López T., Sánchez F.J., Garzón J.C., Muriel C. Spinal anesthesia in pediatric patients // Minerva Anestesiol. – 2012. – № 78. – Р. 78–87.

Атлас регионарной анестезии : пер. с англ. / Дэвид Л. Браун; под ред. В.К. Гостищев. – М. : ООО “Рид Элсивер”, 2009. – 464с. – Перевод изд.: Atlas of Regional Anesthesia. 3th. David L. Brown.

Arthrus O.J., Murray M., Zubier M., Tooley J., Kelsall W. Ultrasongraphic determination of neonatal spinal canal depth // Arch. Dis. Child Fetal. Neonatal. Ed. – 2008. – № 93. – Р. 451–454.

Kokki H., Turunen M., Heikkinen M., Reinikainen M., Laisalmi M. High success rate and low incidence of headache and neurological symptoms with two spinal needle designs in children // Acta Anaesthesiol. Scand. – 2005. – № 49. – Р. 1367–1372.

Всемирная федерация обществ анестезиологов (WFSA) Интенсивная терапия и анестезия у детей [текст] / Практическое руководство: Редакторы: Rachel Homer, Isabeau Walker, Graham Bell (Великобритания). ISSN оригинального издания: : 1353–4882. Редакторы русского издания: Э. В. Недашковский, Ю. С. Александрович, В. В. Кузьков – 2017р. – 182 c.

Нейроаксіальна анестезія. Регіонарні методи знеболення у практиці анестезіолога: Навчальний посібник /Тітов І.І., Волошинський О.В., Попівняк Х.І., Дацюк О.І. – ISBN 978–966-+382-088-0.

Клиническая анестезиология / П.Дж.Бараш, Б.Ф.Куллен, Р.К. Стэлтинг. – М.: Мед.лит., 2010. – 720 с.

Э.А.Сатвалдиева, Д.М.Сабиров Регионарная анестезия у детей: современное состояние и решение проблемы [Текст] / Э. А. атвалдиева, Д.М.Сабиров. – 2009. – №4. – С. 55–59

Айзенберг В.Л. / Регионарная анестезия в педиатрии [Текст] В.Л.Айзенберг, Г.Э. Ульрих, Л.Е. Цыпин, Д.В. Заболотский / Регионарная анестезия и лечение острой боли Том VIII №4 2014. 42–49 c.

Геодакян О.С. Анализ осложнений и побочных эффектов каудальной эпидуральной анестезии у детей / О.С. Геодакян, Л.Е. Цыпин, Е.Г. Агавелян // Вестник интенсивной терапии. – 2004. N1. С. 65–69.

Goldschneider K.R., Brandom B.W. // Reg. Anaesth. Pain Med. 1999. Vol. 24 N 6. – P. 553–556.

Spargo P.M., Abbas S.S. // Anaesthesia. 1999. – Vol 54,N 8. – P. 816

Dalens B, Hasnaoui A. Caudal anesthesia in pediatric surgery: success rate and adverse effects in 750 consecutive patients. Anesth analg 1989; 68: 83–89.

Bosenberg AT et al. Plasma concentrations of ropivacaine following a single-shot caudal block of 1, 2 or 3 mg/kg in children // Acta Anaesth Scand 2001; 10: 1276– 1280.

Breschan C, Jost R, Krumpholz R et al. A prospective study comparing the analgesic efficacy of levobupivacaine, ropivacaine and bupivacaine in pediatric patients undergoing caudal blockade // Paediatr Anaesth 2005; 15: 301–306.

Tsui BC, Berde CB. Caudal analgesia and anesthesia techniques in children // Curr Op Anesthesiol 2005; 18: 283– 288.

Kost-Byerly S, Tobin JR, Greenberg RS, Billett C, Zahurak M, Yaster M. Bacterial colonisation and infectious rate of continuous epidural catheters in children // Anesth Analg 1998; 86: 712–716.

Valairucha S, Seefelder D, Houck CS. Thoracic epidural catheters placed by the caudal route in infants: the importance of radiographic confirmation // Paediatr Anaesth 2002; 12: 424–428.

Bubeck J, Boss K, Krause H, Thies KC. Subcutaneous tunneling of caudal catheters reduces the rate of bacterial colonization to that of lumbar epidural catheters // Anesth Analg 2004; 99: 689–693.

Bösenberg AT. Epidural analgesia for major neonatal surgery // Paediatr Anaesth 1998; 8: 479–483.

Giaufré E, Dalens B, Gombert A. Epidemiology and morbidity of regional anesthesia in children: a one-year prospective survey of the French-language society of pediatric anesthesiologists // Anesth Analg 1996; 83: 904–912.

Eason MJ, Wyatt R. Paravertebral thoracic block-a reappraisal // Anaesthesia. 1979; 34(7): 638–642. doi: 10.1111/j.1365–2044.1979. tb06363.x.

Davies RG, Myles PS, Graham JM. A comparison of the analgesic efficacy and side-effects of paravertebral vs epidural blockade for thoracotomy–a systematic review and meta-analysis of randomized trials // Br J Anaesth. 2006;96(4):418–426. doi: 10.1093/bja/ael020.

Kotze A, Scally A, Howell S. Efficacy and safety of different techniques of paravertebral block for analgesia after thoracotomy: a systematic review and metaregression // Br J Anaesth. 2009; 103(5): 626–636. doi: 10.1093/bja/aep272.

Buckenmaier CC, 3rd, Kwon KH, Howard RS, McKnight GM, Shriver CD, Fritz WT, Garguilo GA, Joltes KH, Stojadinovic A. Double-blinded, placebo-controlled, prospective randomized trial evaluating the efficacy of paravertebral block with and without continuous paravertebral block analgesia in outpatient breast cancer surgery // Pain Med. 2010;11(5):790–799. doi: 10.1111/j.1526– 4637.2010.00842.x.

Schnabel A, Reichl SU, Kranke P, Pogatzki-Zahn EM, Zahn PK. Efficacy and safety of paravertebral blocks in breast surgery: a meta-analysis of randomized controlled trials // Br J Anaesth. 2010; 105(6): 842–852. doi: 10.1093/bja/aeq265.

Terheggen MA, Wille F, Borel Rinkes IH, Ionescu TI, Knape JT. Paravertebral Blockade for Minor Breast Surgery // Anesth Analg. 2002; 94(2): 355–359.

Hadzic A, Kerimoglu B, Loreio D, Karaca PE, Claudio RE, Yufa M, Wedderburn R, Santos AC, Thys DM. Paravertebral blocks provide superior same-day recovery over general anesthesia for patients undergoing inguinal hernia repair // Anesth Analg. 2006; 102(4): 1076–1081. doi: 10.1213/01.ane.0000196532.56221.f2.

Lönnqvist PA, Hildingsson U. The caudal boundary of the thoracic paravertebral space. A study in human cadavers // Anaesthesia 1992; 47: 1051–2.

УДК 616.25.25 (571.56) Анатомо-томографическое обоснование новой межреберной анестезии паравертебральным методом при торакопластических операциях [текст] / А.Ф. Кравченко, В.А. Чуркин, К.Г. Башарин, Б.Д. Гурьев, Е.А. О-Жи-Хо, В.Е Шамаев, Ю.С. Иванов // Дальневосточный медицинский журнал, 2003. – N 4. – С. 39–41

Batra RK, Krishnan K, Agarwal A. Paravertebral block // J Anaesthesiol Clin Pharmacol 2011; 27: 5–11.

Trunk blocks for abdominal surgery / O.Finnerty, J. Carney, J.G. McDonnell[et al] // Journal of association of anaesthetists of great britain and ireland – 2010. – V 65(1). – P. 76–83

R.D. Shah / Applications of regional anaesthesia in paediatrics / R.D. Shah, S. Suresh // British Journal of Anaesthesia. – 2013 – Volume 111. – P.114–124.

World Federation of Sociaties of Anaesthesiologists. // Update in Anaesthesia. випуск №14. 2009. – С. 18.

Біль, знеболювання і інтенсивна терапія, №2, 2014р., Альбокрiнов А. А. БЛОКАДА ПОПЕРЕЧНОГО ПРОСТОРУ ЖИВОТА, ст 50.

Hebbard P. Audit of “rescue” analgesia using TAP block. 12 // Anaesthesia and Intensive Care 2007; 35: 617–618.

Straight A's in Medical-Surgical Nursing by Lippincott Williams & Wilkins (Preparation), Lippincott Williams & Wilkins. 2008. 512 pages

Irwin and Rippe's procedures, techniques and minimally invasive monitoring in intensive care medicine/S. Irwin et all// Lippincott Williams & Wilkins. 2012. p. 344.

Rafi A. Abdominal field block: a new approach via the lumbar triangle // Anaesthesia. 2001; 56: 1024–1026.

McDonnell J, O’Donnell, Brian M, Curley G, Heffernan A, Power C, Laffey J. The Analgesic Efficacy of Transversus Abdominis Plane Block After Abdominal Surgery: A Prospective Randomized Controlled Trial // Anaesthesia and Analgesia. 2007; 104: 193–197

McDonnell J, Laffey J. The Transversus Abdominis Plane Block. 13 // Anesthesia and Analgesia. 2007; 105: 282–283.

Оперативная хирургия и топографическая анатомия. Под ред. В.В. Кованова 4е изд., дополнен. М: Медицина, 2001. С. 185–186.

Jankovic Z. Transversus abdominis plane block: The Holy Grail of anaesthesia for (lower) abdominal surgery // Periodicum Biologorum. 2009; 111(2): 203–208.

Mukhtar K. Transversus Abdominis Plane (TAP) Block // The Journal Of The New York School Of Regional Anesthesia 2009; 12: 28–33.,

Hopkins PM. Ultrasound guidance as a gold standard in regional anaesthesia // Br J Anaesth. 2007 Mar; 98(3): 299–301.

Ludot H. Blocs de la paroi abdominale : apport de l’echographie // Annales Francaises d’Anesthesie et de Reanimation. 2012(31): e21e24.

Ludot H. Blocs de la paroi abdominale : apport de l’echographie // Annales Francaises d’Anesthesie et de Reanimation. 2012(31): e21e24.

Petersen PL, Mathiesen O, Torup H, Dahl JB. The transversus abdominis plane block: a valuable option for postoperative analgesia // A topical review. Acta Anaesthesiol Scand. 2010 May; 54(5): 529–535.

Bjerregaard N, Nikolajsen L, Bendtsen TF, Rasmussen B. Transversus Abdominis Plane Catheter Bolus Analgesia after Major Abdominal Surgery // Anesthesiology Research and Practice. 2012; (2012): 1–5.

Teresa Parras, Rafael Blanco//Блокада грудных нервов под контролем ультразвука (Pecs-I и Pecs-II), Anaesthesia Tutorial of the week/ выпуск №346. 2017.

U-tube video; Dr Amit Pawa, LSORA PECS II Block (accessed 11.10.16).

Povey HM, Jacobsen J, Westergaard-Nielsen J. Subarachnoid analgesia with hyperbaric 0.5 % bupivacaine: Effect of a 60-min period of sitting //Acta Anaesthesiol Scand. 1989; 33: 295–7.

Kuusniemi KS, Pihlajamäki KK, Pitkänen MT, Korkeila JE. A low-dose hypobaric bupivacaine spinal anesthesia for knee arthroscopies // Reg Anesth. 1997; 22: 534–8.

Kuusniemi KS, Pihlajamäki KK, Irjala JK, Jaakkola PW, Pitkänen MT, Korkeila JE. Restricted spinal anaesthesia for ambulatory surgery: A pilot study // Eur J Anaesthesiol. 1999; 16: 2–6.

Imbelloni LE, Beato L, Gouveia MA, Cordeiro JA. Low dose isobaric, hyperbaric, or hypobaric bupivacaine for unilateral spinal anesthesia // Rev Bras Anestesiol. 2007; 57: 261–70.

Imbelloni LE, Beato L, Gouveia MA. Low hypobaric bupivacaine doses for unilateral spinal anesthesia. Rev Bras Anestesiol. 2003;53:579–85.

Imbelloni LE, Beato L, Cordeiro JA. Unilateral spinal anesthesia with low 0.5 % hyperbaric bupivacaine dose // Rev Bras Anestesiol. 2004; 54: 700–6.

Ban C. H. Tsui, M.D., F.R.C.P.C.; Santhanam Suresh, M.D., F.A.A.P.// Ultrasound Imaging for Regional Anesthesia in Infants, Children, and Adolescents: A Review of Current Literature and Its Application in the Practice of Extremity and Trunk Blocks // Anesthesiology 2. 2010, Vol.112, 473–492. doi:10.1097/ALN.0b013e3181c5dfd7.

Blanco R, Fajardo M, Parras Maldonado T. Ultrasound description of Pecs II (modified Pecs I): a novel approach to breast surgery // Rev Esp Anestesiol Reanim. 2012 Nov; 59(9): 470–5.

How to Cite
Haas AI, Koval DO, Haas OO. Regional anesthetics: traditions and innovations. PMJUA [Internet]. 6Sep.2018 [cited 25Sep.2018];3(2):39-2. Available from: