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INTRODUCTION

FOCUS POINTS

  1. Contrary to adults, most pediatric peripheral nerve blocks are placed under general anesthesia.

  2. Peripheral nerve block techniques in children are primarily used as an adjunct to general anesthesia for posteroperative analgesia.

  3. The greatest immediate risk of peripheral nerve blocks is local anesthetic systemic toxicity from inadvertent intravascular injection.

  4. The interscalene block is most optimal for procedures of the shoulder. It may not be ideal for procedures of the forearm and hand because of the chance of ulnar sparing.

  5. The supraclavicular block provides a dense blockade from the humerus to the hand.

  6. The infraclavicular block provides good analgesia from the humerus to the hand and is conducive for indwelling catheter placement.

  7. The axillary approach to the brachial plexus is optimal for procedures distal to the elbow. It misses the musculocutaneous nerve, which needs to be blocked separately.

  8. The femoral nerve block can be used for many surgical techniques involving the thigh and knee, such as skin grafts, mid to distal femur osteotomies, and knee arthroscopies. It can also serve as an adjunct to procedures distal to the knee requiring analgesia to the medial aspect, which is innervated by the saphenous nerve.

  9. The sciatic nerve can be blocked at multiple locations along its course. It is useful for surgical procedures of the hip, thigh, and knee. It is very useful for procedures of the distal lower extremity but needs to be supplemented with a saphenous nerve block for complete analgesia.

  10. The lumbar plexus provides coverage of three peripheral nerves (femoral, obturator, and lateral femoral cutaneous) at a very proximal location, making it a good block for proximal femur and hip procedures.

The advancement in ultrasound technology and development of pediatric appropriate equipment have led to the increased use of regional anesthesia in infants and children. Additionally, the increased awareness of the potential neurotoxic effects of certain anesthetic agents on the developing brain has further prompted interest.1 Although pediatric regional anesthesia is mostly used as an adjunct to general anesthesia or to provide postoperative analgesia, many techniques can be used as an alternative to general anesthesia when it may be difficult or dangerous. It can also be used in the treatment of a variety of acute and chronic pain conditions. The Pediatric Regional Anesthesia Network (PRAN), and the French-Language Society of Pediatric Anesthesiologist (ADARPEF) multi-institutional projects reporting the use and incidence of complications of pediatric regional anesthesia, has concluded that regional anesthesia can be commonly performed in children at a very low complication rate.2–4

INDICATIONS

The choice of anesthesia and regional anesthetic techniques are determined by the comorbidities of the patient and with in-depth consideration of the potential risks and benefits. Important considerations include the type of surgery, surgeon preference, the experience of the anesthesiologist, and the physical and cognitive state of the patient.5 Peripheral regional nerve blockade can improve postoperative pain and patient and/or parent satisfaction. Additionally, ...

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