Regional Anesthesia for Totally Awake Upper Limb Surgery in PEDiatric Population
Condition: Surgery; Anesthesia, Local; Pediatric ALL
Study type: Interventional
Phase: Phase 4

Summary: 
      Peripheral loco-regional anesthesia (LRA) for anesthetic purposes is a technique widely used
      in adults for upper limb surgery. In pediatrics, LRA is not classically considered on its
      own. It is usually performed for analgesic purposes during sedation or general anesthesia. It
      is entirely possible to carry out awakened peripheral blocks in communicating children, of
      school age, thus avoiding the issues of GA in pediatrics, in particular in an emergency
      context. The use of Emla anesthetic skin patches for punctures (perfusion and LRA) as well as
      the viewing of cartoons on touch tablets during treatment can improve the perception of
      painless care such as LRA and treatment.

      In pediatrics, only ropivacaine at a concentration of 0.2% has Marketing Authorization in
      pediatrics in children under 12 for the production of peripheral blocks. On the basis of the
      experience of the Claude Galien Private Hospital in this area, it seems interesting to assess
      the feasibility of upper limb surgery under anesthetic LRA alone with a dose of ropivacaine
      at the concentration 0.35% in communicating children, of school age.
    

Detailed description: 
      Peripheral loco-regional anesthesia (LRA) for anesthetic purposes is a technique widely used
      in adults for upper limb surgery. It allows peripheral surgeries to be performed without
      putting the patient to sleep and thus avoiding certain disadvantages of general anesthesia
      (GA).

      In pediatrics, LRA is not classically considered on its own. It is usually performed for
      analgesic purposes during sedation or GA.

      Subject to respecting a strict protocol and taking advantage of considerable developments in
      the field of LRA, it is entirely possible to carry out awakened peripheral blocks in
      communicating children, of school age, thus avoiding the pitfalls of GA in pediatrics, in
      particular in an emergency context (inhalation on a full stomach, respiratory risk in
      children with colds, inhalational anesthesia with an anxiety mask, postoperative vomiting
      nausea, disorientation and delusions upon waking ...) Indeed, the exclusive use of
      ultrasound, the use of adapted needles, the improvement of knowledge in sono-anatomy, the
      reduction in doses and concentrations of local anesthetics are all developments in the field
      of LRA allowing to improve the conditions of safety, comfort for the patient and success of
      the technique.

      Beyond technical considerations, there are ways to improve the child's experience with care.
      The use of Emla anesthetic skin patches for punctures (perfusion and ALR) as well as the
      viewing of cartoons on touch tablets during treatment can improve the perception of painless
      care such as ALR and treatment. charge in the operating room.

      In pediatrics, only ropivacaine at a concentration of 0.2% has Marketing Authorization in
      pediatrics in children under 12 for the production of peripheral blocks. Higher
      concentrations of ropivacaine, used in several pediatric studies, have nevertheless shown
      their good tolerance and their efficacy Under reserve not to exceed 3mg / kg and to use
      concentrations up to 0.5% On the basis of these arguments, and with the experience of the
      Claude Galien Private Hospital in this area, it seems interesting to assess the feasibility
      of upper limb surgery under anesthetic ALR alone with a dose of ropivacaine at the
      concentration 0.35% in communicating children, of school age.
    

Intervention name(s): local anaesthetic injection
Intervention type(s): Drug
Intervention description(s): Realization by the anesthesiologist of the local anesthesia by single dose of ropivacaine 0.35% in perinervous under ultrasound with distraction by a tablette.
Intervention MeSH terms: Anesthetics; Anesthetics, Local
Intervention model: Single Group Assignment
Intervention model description: monocentric, interventional, longitudinal, prospective, non-comparative.
Masking: None (Open Label)
Primary purpose: Supportive Care
Keywords: surgery; local anesthesia; Pediatric; Ropivacaine