P237 It is all about the guidelines: developing pathways for peripheral nerve blocks in pediatrics

Elena Ivanova; Margarita Borislavova

doi:10.1136/rapm-2024-ESRA.400

Abstract

Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page)

Background and Aims Pediatric anesthesia holds many challenges. Pediatric regional anesthesia is even more demanding. We emphasize on developing relevant guidelines and apply them in everyday practice to provide adequate, safe regional anesthesia in pediatrics. Protocols include performing guidelines, intra- and postoperative evaluation and parent questionnaire.

Methods Our center, as the biggest pediatric emergency center in the country, developed pediatric peripheral nerve blocks guidelines. The experience gained in variety of pediatric trauma and orthopedics, led to the need of pediatric regional anesthesia procedure unification. Preoperative guideline includes patients’ personal data, ASA, diagnosis, oral premedication. Intraoperatively, we record intervention, patients’ vital signs, induction, maintainance, emerge of anesthesia, type, time, onset of peripheral nerve block, opioid consumption, local anesthetics, complications. Postoperative analgesia is evaluated via VAS (8y-18y) and BOPS (1y-7y). Children under 1year are rarely subject to orthopedic surgery but if so, we recommend general anesthesia plus regional. Postoperative evaluation is estimated during the first 2days. We developed and applied a questionnaire, handed both to parent and child, in order to estimate their personal satisfaction, feeling and perception.

Results Essential part of anesthesiologists’ work is patient analgesia and satisfaction. This might be troubled in pediatrics, taking in mind their age and level of communication. We found better results after introducing strict pathways for managing, performing and evaluating peripheral nerve blocks in pediatrics.

Conclusions Pain relief in children is of crucial importance. Successful peripheral nerve blocks in pediatrics require validated guidelines, strict protocol and close monitoring. We encourage parents’ involvement via questionnaire.