Local Anaesthetic Infusion (Paediatric Guidelines)

TAM (Treatments and Medicines) NHS Highland
NHS Highland

  • Local anaesthetic infusions (L.A) may only be used in the following areas:
    Children’s Ward
    SHDU
    ITU
    Theatre and Recovery areas

  • Nerve and local anaesthetic infusions are used for post-operative
    Analgesia for the following surgery:
    Lower limb surgery
    Upper limb surgery
    Wound infiltration

  • The 5ml/hr pumps only should be used in paediatric patients
  • The child must weigh more than 15kg All L.A. infusions must be delivered via the Braun Easy-pump device, which is a single use device.
  • The Braun Easypump device must be filled in theatre under aseptic conditions i.e. gown, mask, and gloves.
  • The pump must not be re-filled under any circumstances.
  • The pump may be filled by anaesthetists, the acute pain nurse or by anaesthetic assistants who have received training in the filling of the Braun Easypump device.
  • The system circuit must not be broken unless the Braun Easypump device has be disconnected for emergency reasons.
  • The surgical team should be called for all routine surgical problems.

    Nausea and vomiting
    Hypotension
    Sedation and respiratory problems
    Urinary retention

  • If further advice is required, the surgical medical staff may contact the Acute Pain Nurse (Bleep 1003) and if not available, the On call/duty anaesthetist.
  • The Acute Pain Nurse, On call/duty anaesthetist or the responsible Consultant anaesthetist must be contracted for inadequate analgesia or early signs of local anaesthetic toxicity including:
    Flushed face
    Numbness or tingling of lips or tongue
    Tinnitius
    Light headedness
    Drowsiness
    Twitching
    Please clamp off the pump if such symptoms/signs should arise.

Nursing Management

  • All registered nurses caring for a child with a local anaesthetic infusion must have received training in the management of continuous local anaesthetic infusion and the Braun Easypump Device.
  • Routine post-op care should be given unless instructed to do otherwise by the anaesthetist.
  • Pain, nausea, sedation, motor block (lower limb only) and signs of toxicity observations should be carried out:
    Recovery: Every 15 minutes
    On ward: Hourly for 4 hours
    2 hourly thereafter
  • The Braun Easypump Device and local anaesthetic catheter exit site must be checked 2 hourly for disconnections, leakage or signs of infection.
  • If you are concerned that the Braun infusion may not be infusing please contact the Acute Pain Nurse or the On Call/Duty anaesthetist.
  • The system circuit must not be broken at any time unless the child is developing signs of local anaesthetic toxicity.
  • Ensure a patent I.V. cannula whilst the local anaesthetic infusion is in progress.
  • Administer prescribed regular and breakthrough oral analgesia.
  • Children with lower limb local anaesthetic nerve blocks must have support when mobilising.

Treatment of Acute Problems

1. Inadequate Analgesia
If the pain score is greater than 4 for more than one set of observations do the following:

    • Ensure that regular oral/rectal analgesia has been prescribed and administered.
    • Use breakthrough opioid/simple analgesic as able
    • Ensure that the pump is connected and the clamp is open.
    • Consider reasons for any increase in the pain e.g. surgical complications and ask for surgical review
    • Contact the Acute Pain Nurse, the responsible anaesthetist or the On Call/Duty anaesthetist for advice.

2. Hypotension

    • Hypotension is not usually due to the local anaesthetic block but may be caused by bleeding, sepsis, anaphylaxis, myocardial insufficiency or hypoxia. The cause should be identified and managed. If LA toxicity is questioned see management outlined below.

3. Mobility

      • Mobilise with support at all times as children with lower limb local Anaesthetic infusions they may have leg weakness and be unable to weight bear.
      • Children with lower limb motor block must be assessed as “high risk” for pressure sores.

4. Signs of L.A. Toxicity

    • Early signs and symptoms include :
      Tinnitus
      Flushed face
      Lightheaded
      Slurred speech
      Muscle twitching
    • Late signs and symptoms include:
      Profound hypotension
      Bradycardia or ventricular arrhythmias
      Seizures
      Drowsiness
      Coma
      Respiratory / cardiac arrest
    • If any of the above signs and symptoms
      • Clamp the Braun Easypump line.
      • Contact Medical staff & the On Call/Duty Anaesthetic urgently.
      • CALL 2222 AND INITIATE CPR PROCEDURES IF THE CHILD IS APNOEIC
      • Obtain lipid rescue bag – ClinOleic 20% stored in pharmacy cupboard, theatre corridor (bleep 1089 for access) and labour suite.

Removal of Local Anaesthetic Catheter

  • Explain the procedure to the child and parent/carer.
  • An aseptic technique must be used throughout the procedure.
  • Wash hands thoroughly before starting the procedure
  • Remove the dressing and wash hands again
  • Clean the area around the catheter insertion site
  • Using sterile gloves, place a sterile swab to the skin at the catheter insertion site
  • With another swab, hold the catheter and gently pull to remove it
  • Once the catheter has been removed, cover the site with an airstrip plaster and settle the child in a comfortable position
  • Check catheter tip to confirm that it is intact.

Editorial Information

Last reviewed: 30/09/2021

Next review date: 30/09/2024

Author(s): Acute Pain Team.

Version: 2

Approved By: TAM Subgroup of ADTC

Reviewer name(s): Acute Pain Nurse Specialist.

Document Id: TAM324