2018, Number 3
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ABSTRACTThe history of regional anesthesia goes back to the discovery of cocaine in 1884 by Koeller. Since then its development has been accelerated achieving a preponderant place in the daily practice of anesthesia. Its range of benefits is very wide, but as any other technique, requires experience and expertise. Its use in neonates, infants and children, either as a sole anesthetic or combined with inhaled anesthesia, provides anesthesia and analgesia during and postoperatively. Local anesthetics block propagation of nerve impulses along the nerve fibers by inactivation of voltage-gated sodium channels; its action is not limited only to the sodium channels involved in nerve transmission, but also in those of other tissues like the central nervous and cardiovascular systems, as occurs in cases of overdose or massive absorption during inadvertent intravascular injection, which can lead to serious complications with life risk. Local anesthetic systemic toxicity (LAST) has to be recognized and treated immediately; new guidelines have been issued and clinicians have to be aware of them. The introduction of ultrasound guided blocks has revolutionized the practice of regional anesthesia particularly in small children where anatomy can be easily identified. This technique shows a clear advantage over the use of a neurostimulator or those based on anatomical landmarks, by allowing a clear visualization of neuraxial structures, shorter time to perform the block, reduced time to block onset and use of a smaller volume of local anesthetic. Regional anesthesia continuous to evolve towards improvement and safety.
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