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Modern pediatric anesthesia would not be conceivable without the use of regional anesthetic techniques. For instance, regional anesthesia decreases the need for mechanical ventilation following major thoracic or abdominal surgery. In addition, the need for intraoperative and postoperative opioids decreases accordingly. Perhaps most importantly, the entire perioperative experience is less stressful for children whose perioperative pain is adequately managed. Most of the advantages of perioperative regional anesthesia are demonstrated in central neuraxial blocks, specifically for caudal continuous lumbar or thoracic epidural blocks.

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In contrast to central blocks, peripheral nerve blocks (PNBs) have not been studied extensively in children. A Medline search in April 2005 yielded 42 reports for pediatric anesthesia & epidural and only 17 for pediatric anesthesia & peripheral nerve block. This finding suggests that peripheral nerve blockade in children is used less frequently in clinical practice than in adults. This is compounded by the fact that some pediatric anesthesiologists are still reluctant to use the nerve stimulator, the accepted standard tool for locating nerves in adults. “Blind” methods, such as those used for blockade of the ilioinguinal/iliohypogastric nerves, continue to be the most prevalent approach in pediatric anesthesia. Even techniques that today are used exclusively in conjunction with nerve stimulators in adults, are frequently performed “blind” in children by using anatomic landmarks as the sole reference or by relying on fascial click techniques. Giaufré and coworkers1 reported in a much-quoted overview article on a study performed under the auspices of the French Language Society of Pediatric Anesthesiologists (ADARPEF). In that study, a total of 24,409 regional anesthetic procedures were performed in children over a 1-year period, 15,013 (>60%) of them being central blocks. By comparison, only 38% of these were peripheral blocks. In this large series, no complications were reported, suggesting that PNBs in children can be used with remarkable safety. However, it is possible that some complications were minor or went clinically undetected. For example, complications during blockade of the ilioinguinal/iliohypogastric nerves were not observed in that study. It is unlikely that complications were virtually nonexistent, since the conventional techniques described are well known to carry a risk of peritoneal puncture.

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Ultrasound-guided nerve blocks are rapidly becoming popular in adults. The smaller body size of children, allows the use of high-frequency, high-resolution probes, making ultrasound particularly suitable to the practice of PNBs in the pediatric patient. The reader should be advised that at the time of the publication of this book, this area of regional anesthesia is still in its infancy and scientific data on the true efficacy and safety of ultrasound-guided nerve blocks in children are limited. Consequently, some views expressed in this chapter necessarily reflect our own bias and clinical experience. Finally, because of our group's specific interest in anesthesia for pediatric trauma, most discussion in this chapter focuses on blocks in pediatric patients with traumatic injury of the upper and lower extremities.

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