Pediatric Regional Anesthesia: A Review and Update

Abstract

Purpose of Review: This review summarizes the main regional anesthesia techniques currently in use for pediatric patients and identifies the recent evidence for their safety and efficacy. Recent Findings: The Pediatric Regional Anesthesia Network (PRAN) database with over 115,000 documented nerve blocks has addressed the question of safety for a variety of techniques. PRAN has demonstrated that caudal epidural blocks, interscalene brachial plexus blocks, transversus abdominus plane (TAP) blocks, and neonatal caudal catheters have been routinely performed under general anesthesia in the pediatric population without significant report of adverse events. Randomized controlled trials have shown that paravertebral catheters perform favorably compared to thoracic epidurals for thoracic procedures without the side effects of hypotension and urinary retention. Summary: Pediatric nerve blocks continue to grow as the new standard for pediatric pain control. Concerns about performance of blocks under general anesthesia have largely been eliminated now that ultrasound guided blocks are routine. New horizons include truncal blocks including TAP, quadratus lumborum, paravertebral blocks, and catheters as well as increasing performance of extremity blocks, even in the setting of trauma.