Abstract
Central and peripheral blocks are increasingly used for surgical operations in children. In most circumstances a general anesthesia must be performed first because regional anesthesia techniques are painful and it is needed that the child be immobile during the performance of blocks. However, a deep general anesthesia or heavy sedation could mask any warning signal that something is going wrong, like an excruciating pain that alerts possible damage of important nervous structures. To minimize the risks, deep general anesthesia or heavy sedation should be avoided. Central blocks carry the risk of rare but important neurological sequelae. Therefore, whenever it is possible, peripheral blocks are preferable. However, for severe operations when a long-lasting postoperative pain is expected, or in case of chronic pain, a central block is preferable. Recent knowledge about the mechanism of acute and chronic pain seems to suggest the opportunity of using of central perimedillar blocks to inject the appropriate drugs just close to the spinal cord. Copyright 2002, Elsevier Science (USA). All rights reserved.
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