Cover Page

Cite item


It is known that newborns and infants feel the pain and require the proper analgesia in any surgical manipulations. Significant changes in the prolonged regional analgesia have occurred in newborns within the last several years. The main problems observed during analgesia are the lack of objective methods of pain measurement, lack of speech contact with a child and age restrictions to use some analgesics. It is currently established that epidural anesthesia in newborns and infants is recommended as a safe and effective method of anesthesia. The drug of choice for epidural anesthesia in this age group is Ropivacainum 2 mg/ml. Discussion of the most suitable method of epidural administration of Ropivacainum in combination with narcotic analgesics is being continued.

About the authors

S. Yu. Sichkar

N.I. Pirogov Russian National Research Medical University

Author for correspondence.
Email: ovenka-cool@rambler.ru
Russian Federation

I. I. Afukov

N.F. Filatov’s Children’s Municipal Clinical Hospital No. 13 of the Ministry of Health of Moscow

Email: afukovdoc@yandex.ru
Russian Federation


  1. Агавелян Э.Г. Каудальная эпидуральная анестезия комбинацией бупивакаина и промедола у детей: Дисс. … канд. мед. наук. - М., 1996.
  2. Александрович Ю.С., Пшениснов К.В. Интенсивная терапия новорожденных: Руководство для врачей. - СПб.: изд-во «Н-Л», 2013. С. 605-607.
  3. Айзенберг В.Л., Ульрих Г.Э., Цыпин Л.Е., Заболотский Д.В. Регионарная анестезия в педиатрии. - СПб., 2011. - 304 с.
  4. Вальдман А.В. Боль как эмоционально-стрессовая реакция и способы ее антиноцицептивной регуляции // Вестник АМН СССР. 1980. № 9. С. 11-17.
  5. Волчков В.А., Игнатов Ю.Д., Страшнов В.И. Болевые синдромы в анестезиологии и реаниматологии. - М., 2006.
  6. Жиркова Ю.В. Профилактика и лечение болевого синдрома у новорожденных с хирургическими заболеваниями: Дисс. … д-ра мед. наук. - М., 2011.
  7. Жиркова Ю.В., Зильберт Е.В., Манерова А.Ф., Степаненко С.М. Поведенческие реакции на острую боль у новорожденных детей с хирургическими заболеваниями // Анестезиология и реаниматология. 2003. № 1. С. 17-20.
  8. Исаков Ю.Ф., Гераськин В.И., Кожевников В.А. Длительная перидуральная анестезия после операций на органах грудной клетки у детей // Грудная хирургия. 1971. № 13. С. 104.
  9. Калюжный Л.В. Физиологические механизмы регуляции болевой чувствительности. - М.: Медицина, 1984. С. 6-62.
  10. Лукин Г.И. Применение перидуральной анестезии в хирургии новорожденных: Дисс.…канд. мед. наук. - М., 1983.
  11. Насекин М.В., Острейков И.Ф., Бабаева Б.Д. Эпидуральная анестезия под ультразвуковым контролем у детей //Анестезиология и реаниматология. 2013. № 1.
  12. Ражев С.В., Степаненко С.М., Сидоров В.А., Лешкевич А.И. и др. Этюды регионарной анестезии у детей. - М., 2001. - 192 с.
  13. Ражев С.В. Особенности спинальной анестезии у детей. - М., 1998.
  14. Ражев С.В., Михельсон В.А., Степаненко С.М., Геодакян О.С. Регионарная анестезия у детей. - М., 1998.
  15. Сепбаева А. Д. Анестезиологическая защита при оперативных вмешательствах у новорожденных детей: Дисс. …д-ра мед. наук. - М., 2009.
  16. Bader А.М., Datta S., Flanagan Н., Covino В. G. Comparison оf bupivacaine- and ropivacaine-induced conduction in blockade in the isolated rabbit vagus nerve // Anesth. Analg. 1989. Vol. 68, N 6. Р. 724-727.
  17. Berde C.B. Toxicity of local anesthetics in infants and children // J. Pediatr. 1993. Vol. 122, N 5 (Pt. 2). Р. 14-20.
  18. Berge C.B. Convulsions associated with pediatric regional anesthesia // Anasth. Analg. 1996. Vol. 82. Р. 231-234.
  19. Berde C.B. Convulsions associated with pediatric regional anesthesia // Anesthesia Analgesia. 1992. Vol. 75, N 2. Р. 164-166.
  20. Berti М., Fаnеlli G., Casati А., Albertin А., Palmisano S., Deni F., Perotti V., Torri G. Patient supplemented epidural analgesia after major abdominal surgery with bupivacaine/fentanyl оr ropivacaine/fentanyl // Can. J. Аnаеsth. 2000. Vol. 47, N 1. Р. 27-32.
  21. Bielsky A., Efrat R., Suresh S. Postoperative analgesia in neonates after major abdominal surgery: «TAP» our way to succes // Paediatric. Anaesthesia. 2009. Vol. 19, N 5. Р. 541-542.
  22. Bosenberg A.T. Epidural analgesia for major neonatal surgery // Paediatric Anaesthesia. 1998. Vol. 8, N 6. Р. 479-483.
  23. Bosenberg A.T., Wiersma R., Hadley G.P. Oesophageal atresia: caudothoracic epidural antsthesia reduces the need for post- operative ventilatory support. // Pediatr. Surg. Int. 1992. Vol. 7. Р. 289-291.
  24. Bosenberg A.T., Cronje L., Thomas et al. Ropivacaine plasma levels and postoperative analgesia and infants during 48-72 h continuous epidural infusion following major surgery // Pediatr. Anaesthesia. 2003. Vol. 13. Р. 851-852.
  25. Breschan C., Hellstrand E., Likar R. et al. Early sings of tocity and «subtoxic» conditions in infant monitoring. Bupivacaine plasma levels following caudal anesthesia // Anaesthesist. 1998. Vol. 47, N 4. Р. 290-294.
  26. Breschan C., Krumpholz R., Jost R., Likar R. Intraspinal haematoma following lumbal epidural anesthesia in a neonate //Paediatric. Anasthesia. 2001. Vol. 11. Р. 105-108.
  27. Bromage P.R., Benumof J.L. Paraplegia following intracord injection during attempted epidural anesthesia under general anesthesia // Reg. Anesthes. Pain Med. 1998. Vol. 23. Р. 104-107.
  28. Campbell D.C., Zwack R.M., Crone L.-A. L., Yip R.W. Ambulatory labor epidural analgesia: bupivacaine versus ropivacaine // Anesth. Analg. 2000. Vol. 90. Р. 1384-1389.
  29. Campbell F.A., Yentis S.M. et al. Analgesic efficacy and safety of a caudal bupivacaine-fentanyl mixture in children //Can. J. Anaesth. 1992. Vol. 39. Р. 661-664.
  30. Chazalon P., Tourtier J.P., Villevielle T. et al. Ropivacaine-induced cardiac arrest after peripheral nerve block: successful resuscitation // Anesthesiology. 2003. Vol. 99. Р. 1449-1451.
  31. Casati A., Moizo E., Marchetti C., Vinciguerra F. A prospective, randomized, double-dlind comparison of unilateral spinal anesthesia with hyperbaric bupivacaine, ropivacaine, or levobupivacaine for inguinal herniorrhaphy // Anesth. Analg. 2004. Vol. 99. P. 1387-1392.
  32. Dalens B., Tanguy A., Haberer J.P. Lumbal epidural anesthesia for operative in infants and young children // Anesth. Analg. 1986. Vol. 65. Р. 1069-1073.
  33. Eather K.F. Regional analgesia for infants and children // J. Anaesth. Clin. 1975. Vol. 13. P. 19-48.
  34. Ecoffey C., Dubousset A.M., Samii K. Lumbar and thoracic epidural anesthesia for urologic and upper abdominal surgery in infants and children // Anesthesiology. 1986. Vol. 65. Р. 87-90.
  35. Etches R.C., Writer W.D., Ansley D., Nydahl Р.А., Ong В.Y., Lui А., Badner N., Kawolski S., Muir Н., Shukla R., Beattie W.S. Continuous epidural ropivacaine 0.2% for analgesia after lower abdominal surgery // Anesth. Analg. 1997. Vol. 84, N 4. Р. 784-790.
  36. Gielen M., Slappendel R., Jack N. Successful defibrillation immediately after the intravascular injection of ropivacaine //Can. J. Anesth. 2005. Vol. 52. Р. 490-492.
  37. Goldman L.J. Complications in regional anaesthesia // Paed Anaesth. Analg. 1996. Vol. 5. Р. 3-9.
  38. Graf В.М., Abraham I., Eberbach N., Kunst G., Stowe D.F., Martin Е. Differences in cardiotoxicity of bupivacaine and ropivacaine are the result of physicochemical and stereoselective properties // Anesthesiology. 2002. Vol. 96, N 6. Р. 1427-1434.
  39. Groban L., Deal D.D., Vernon J.C., James R.L., Butterworth J. Cardiac resuscitation after incremental overdosage with lidocaine, bupivacaine, levobupivacaine, and ropivacaine in anesthetized dogs // Аnesth. Analg. 2001. Vol. 92, N 1. Р. 37-43.
  40. Hertzka R.E., Gauntlett I.S., Fisher D.M., Spellman M.J. Fentanyl-induced ventilatory depression effects of age //Anesthesiology. 1989. Vol. 70, N 2. Р. 213-218.
  41. Hodgkinson R. Total spinal block after epidural injection into an interspace adjacent to an inadvertent dural perforation //Anesthesiology. 1981. Vol. 55. Р. 593.
  42. Hubler M., Gabler R., Ehm B., Oertel R., Gama de Abreu1 M., Koch T. Successful resuscitation following ropivacaineinduced systemic toxicity in a neonate // Anaesthesia. 2010. Vol. 65. Р. 1137-1140.
  43. Ivani G., Lampugnani Е., De Negri Р., Lonnqvist Р.А., Broadman L. Ropivacaine vs bupivacaine in major surgery in infants // Can. J. Аnаеsth. 1999. Vol. 46, N 5 (Pt. 1). Р. 467-469.
  44. Ivani G., Lampugnani E., Torre M., Caleo-Maria G., DeNegri P., Borometi F., Messeri A., Calamandrei M., Lonnqvist P.A., Morton N.S. Comparison of ropivacaine with bupivacaine for paediatric caudal block // Br. J. Anaesth. 1998. Vol. 81. Р. 247-248.
  45. Kampe S., Weigand C., Kaufmann J., Кlimek М., Konig D.Р., Lynch J. Postoperative analgesia with по motor block bу continuous epidural infusion of ropivacaine 0.1% and sufentanil after total hip replacement // Anesth. Analg. 1999. Vol. 89, N 2. Р. 395-398.
  46. Khoo L.P., Corbett A.R. Successful resuscitation of an ASA 3 patient following ropivacaine- induced cardiac arrest //Anaesth. Intens. Care. 2006. Vol. 34. Р. 804-807.
  47. Knudsen K., Beckman S.M., Blomberg S., Sjovall J., Edvardson N. Cebtral nervous and cardiovascular effects of i.v. infusions of ropivacaine, bupivacaine and placebo in volunteers // Br. J. Analges. 1997. Vol. 78. Р. 507-514.
  48. La-Kokko T.I., Partanen A., Karinen J., bKiviluoma K., Alahuhta S. Pharmacokinetics of 0.2% ropivacaine and 0.2% bupivacaine following caual blocks in children // Anaesthesiol. Scand. 2002. Vol. 44. Р. 1099-1102.
  49. Lemmon W.T. A method for continuos spinal anesthesia // Analgesia Surg. 1940. Vol. 111. Р. 141-144.
  50. Larsson B., Lundeberg S., Olsson G. Epidural abscess in a one-year-old boy after continuos epidural analgesia // Anesth. Analg. 1997. Vol. 84. Р. 1245-1247.
  51. Larsson B.N., Lonnqvist P.A., Olsson G.L. Plasma concentrations of bupivacaine in neonates after continuos epidural infusion // Anesth. Analgesia. 1997. Vol. 84, N 3. Р. 501-505.
  52. Locatelli B., Ingelmo P., Sonzogni V. et al. Randomized, double-blind, phase III, controlled traial comparing levobupivacaine 0,25% and bupivacaine 0,25% by the caudal route in children // Br. J. Anaesthesia. 2005. Vol. 94, N 3. Р. 366-371.
  53. Markey J.R. Naseer O.B., Bird D.J. Rabito S.F., Winnie A.P. Transient neurologic symptoms after epidural analgesia //Anesth. Analg. 2000. Vol. 90. Р. 437-439.
  54. McCloskey J.J., Haun S.E., Deshpande J.K. Bupivacaine toxicity secondary to continuous caudal epidural infusion in children // Anesth. Analgesia. 1992. Vol. 75, N 2. Р. 287-290.
  55. Моrrisоn S.G., Dominguez J.J., Frascarolo Р., Reiz S. А comparison of the electrocardiographic cardiotoxic effects of racemic bupivacaine, levobupivacaine, and ropivacaine in anesthetized swine // Аnesth. Analg. 2000. Vol. 90, N 6. Р. 1308-1314.
  56. Murrell D., Gibson P.R., Cohen R.C. Continuous epidural analgesia in newborn infats undergoing major surgery //J. Pediatr. Surg. 1993. Vol. 28, N 4. Р. 548-552, discussion 552-553.
  57. Ohmura S., Kawada М., Ohta T., Yamamoto К., Kobayashi T. Systemic Toxicity and Resuscitation in Bupivacaine-, Levobupivacaine- or Ropivacaine-Infused Rats // Аnesth. Analg. 2001. Vol. 93, N 3. Р. 743-748.
  58. Rapp H.J., Molnar V., Austin S. et al. Ropivacain in neinates and infants: pharmacokinetic evalution following single caudal block // Pediatr. Anaesth. 2004. Vol. 14, N 9. Р. 724-732.
  59. Purcell-Jones G., Dormon F., Sumner E. Pediatric anaesthests perceptions of neonatal and infant pain // Pain. 1988. Vol. 33. Р. 181-187.
  60. Rosenberg Р.Н., Heinonen Е. Differential sensitivity о f А and С nerve fibres to long-acting amide local anaesthetics //Br. J. Аnаеsth. 1983. Vol. 55, N 2. Р. 163-167.
  61. Scott D.А., Chamley D.М., Мооnеу Р.Н., Deam R.K., Mark А.Н., Hagglof В. Epidural ropivacaine infusion for postoperative analgesia after major lower abdominal surgery: а dose finding study // Anesth. Analg. 1995. Vol. 81. Р. 982-986.
  62. Schug S.А., Scott D.А., Paуne J., Mooney P.H., Hagglof В. Postoperative analgesia bу continuous extradural infusion оf ropivacaine after upper abdominal surgery // Br. J. Аnaesth. 1996. Vol. 76, N 4. P. 487-491.
  63. Shah S., Goplakrishan S., Apuya J. et al. Use of Itralipid in an infant with im impending cardiovascular collapse due to local anesthetic toxicity // J. Anesth. 2009. Vol. 23, N 3. P. 439-441.
  64. Scott D.B., Lee A., Fagan D., Bowler GMR., Bloomlfield P., Lundh R. Acute toxicity of ropivacaine compared with that of bupivacaine // Anesth. Analgesia. 1989. Vol. 69. P. 563-569.
  65. Scott D.А., Вlаke D., Buckland M., Etches R., Halliwell R., Marsland C., Merridew G., Murphy D., Paech M., Schug S.А., Turner G., Walker S., Huizar K., Gustafsson U. А comparison of epidural ropivacaine infusion alone and in combination with 1, 2, and 4 g/mL fentanyl for seventy-two hours of postoperative analgesia after major abdominal surgery // Anesth. Analg. 1999. Vol. 88. P. 857-864.
  66. Silvani P., Camporesi A., Agostino M.R., Salvo I. Caudal anesthesia in pediatrics: an update // Minerva Anestesiol. 2006. Vol. 72, N 6. P. 453-459.
  67. Uguralp S., Mutus M., Koroglu A., Gurbuz N., Koltuksuz U., Demircan M. Regional anesthesia is a good alternative to general anesthesia in pediatric surgery: Experice in 1,554 children // J. Pediatr. Surg. 2002, Apr. Vol. 37, N 4. P. 610-613.
  68. Wolf A.R. Pain, nociception and the developing infant // Paediatr. Anaesthes. 1999. Vol. 9, N 1. P. 7-17.
  69. Wood C.E., Goresky G.V., Klassen K.A. et al. Complications of continuos epidural infusions for postoperative analgesia in children // Can. J. Anaesthesia. 1994. Vol. 41. P. 613-620.

Copyright (c) 2015 Sichkar S.Y., Afukov I.I.

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: ПИ № ФС 77 - 81892 от 24.09.2021 г.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies