Practical pediatric regional anesthesia

Abstract

To discuss the developments in pediatric regional anesthesia which are currently under discussion and relevant to the practitioner. The ongoing interest in regional anesthesia for pain relief is justified by its inclusion in current pain guidelines as well as by a good safety record in the recent epidemiological studies. Abdominal wall blocks, for example, transversus abdominis plane block, are emergent techniques and widely used; however, there are still unanswered questions, for example, the duration of analgesia. Caudal block still remains the single most important technique. According to the recent meta-analyses, the duration of analgesia can be prolonged by approximately 4 h by the addition of clonidine to the local anesthetics. On the other hand, there is some consensus emerging that ketamine should probably be abandoned as an additive to local anesthetics. Ultrasound is increasingly being used for a variety of regional anesthetics. For caudal blocks, it probably should be used mainly for teaching purposes or in cases of anatomical variants. The visible difference between the anatomical and the clinical spread revives the discussion on the exact site of action of an epidural block. Pediatric regional anesthesia is still a developing field, both clinically and scientifically.