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By H. Renck, A. Johansson, P. Aspelin, H. Jacobsen (auth.), Jack W. Van Kleef Md, Anton G. L. Burm Msc, Johan Spierdijk Md (eds.)

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Pioneers of techniques were 1908 1920 1933 1936 1971 Grey Farr Campbell Sievers Isakob Spinal anaesthesia (7) Brachial plexus blockade (4) Caudal epidural anaesthesia (2) Lumbar epidural anaesthesia (12) Thoracic epidural anaesthesia (8) There are important anatomical differences between the child and the adult. They are shown in Table 1. Table 1 Anatomical differences in children and adults of importance in regional anaesthesia Neonate Postion of lower end of spinal cord Position of lower end of dural sac Infant L3 84 (one case) Small child Older Child Adult Ll at 12 mths Ll S2 82 C8F per kg 4 ml 4 ml 3 ml 2 ml 2 ml Condition of epidural fat loose loose loose + loose 7-8 years firmly packed It might be added that the card~o-vascular system of children is considerably more stable than in the adult.

It illustrates the volumes used for interscalene brachial plexus blocks. 5 mg/kg of bupivacaine. The technique used 40 here is the "Short Needle Technique" described by Fortin. (5) It avoids contact ·with the first rib. The axillary approach of the brachial plexus is probably the most popular one in children. surgical intervention. Again the technique of the axillary block is not much different from the adult. The dosages of local anaesthetics have been evaluated by Eriksson (3) and Niesel (9) as shown in table 5.

Axillary brachial plexus anaesthesia in children with citanest. Acta Anaesthesiol. Scand. 16:291 4. E. 1920. Local anesthesia in infancy and childhood. Arch. Pediatr. 37:381 41 5. Fortin G, Tremblay L. 1959. The short-needle technique in brachial plexus block. Can. Anaesth. Soc. J. 6:32 6. A. 1970. Anest. 4:503 7. Gray T. 1910. Study of spinal anaesthesia in infants and children. Lancet 10:10 1909: and 10:6 8. A. 1971. Long term peridural anesthesia after operations on the organs of the chest in children.

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