Management of Acute Pain in Children: Pharmacologic

Local Anesthetics and Regional Anesthesia (continued)

Infiltration of Local Anesthetics

When topical local anesthesia is not feasible because of time constraints in urgent or emergent situations, infiltration of 1% lidocaine to an intended puncture site can significantly reduce the pain associated with venous or arterial cannulation. Intradermal injection pain can be significantly lessened by the use of a smaller needle, and buffering of the local anesthetic with the addition of sodium bicarbonate (4 ml lidocaine mixed with 1 ml sodium bicarbonate).⁵⁴ A bioinjector has also recently been introduced which uses compressed CO2 to inject the lidocaine rapidly beneath the skin. Clinical experience has shown that hydration decreases the pain of local anesthesia. One to 2 glasses of water (if the patient is able to drink) will help the initial pain of the block.

Regional Anesthesia and Analgesia

Regional anesthetic techniques are commonly used in children to decrease general anesthetic requirements and aid in postoperative pain management. As with adults, multimodal analgesia techniques using combinations of local anesthetics, nonsteroidal anti-inflammatory agents and opioids provide optimal analgesia. In young children, single-shot caudal injections of local anesthetics are easy to perform for outpatient and short-stay surgeries. Continuous epidural analgesia via indwelling catheters can provide excellent postoperative analgesia for infants and children of all ages undergoing more extensive abdominal and lower extremity procedures.