TY - CHAP M1 - Book, Section TI - Regional Anesthesia: Upper and Lower Extremity Blocks A1 - Vecchione, Tricia A2 - Ellinas, Herodotos A2 - Matthes, Kai A2 - Alrayashi, Walid A2 - Bilge, Aykut Y1 - 2021 N1 - T2 - Clinical Pediatric Anesthesiology AB - FOCUS POINTSContrary to adults, most pediatric peripheral nerve blocks are placed under general anesthesia.Peripheral nerve block techniques in children are primarily used as an adjunct to general anesthesia for posteroperative analgesia.The greatest immediate risk of peripheral nerve blocks is local anesthetic systemic toxicity from inadvertent intravascular injection.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.The supraclavicular block provides a dense blockade from the humerus to the hand.The infraclavicular block provides good analgesia from the humerus to the hand and is conducive for indwelling catheter placement.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.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.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.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. SN - PB - McGraw Hill CY - New York, NY Y2 - 2024/03/28 UR - accessanesthesiology.mhmedical.com/content.aspx?aid=1176459485 ER -