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Regional anesthesia in pediatrics: marching forward

Boretsky, Karen R.

Current Opinion in Anaesthesiology: October 2014 - Volume 27 - Issue 5 - p 556–560
doi: 10.1097/ACO.0000000000000106
REGIONAL ANESTHESIA: Edited by Jacques E. Chelly

Purpose of review: This review highlights new data and current trends of well tolerated and effective paediatric regional anesthesia. Historically, the practice of paediatric regional anesthesia was based largely on information from adult studies, but recent literature contains information on paediatric specific risks and benefits of old and new techniques as well as the impact of new ideas and technologies.

Recent findings: Excellent pain relief with regional anesthesia is well demonstrated in children. Several databases of paediatric regional anesthesia (over 46 000 regional anesthetics) demonstrate overall safety and lack of major complications. Detailed analysis demonstrates additional safety and decreased failure rates of peripheral compared with neuraxial nerve blocks. Ultrasound technology confers additional safety and efficacy benefits.

Increasingly, data support the safety and efficacy of novel peripheral nerve blocks, transversus abdominis plane and ultrasound-guided paravertebral, and the use of perineural catheters for both inpatients and outpatients. Regional anesthesia as a sole agent for surgical anesthesia and the use of regional anesthesia for pain in nonsurgical pain patients remains underutilized.

Summary: Paediatric specific data for regional anesthesia are available to help guide optimal pain management. The paediatric regional anesthesia literature lags behind literature available for adult populations and increased studies are needed for additional information for informed decision-making.

Boston Children's Hospital, Boston, Massachusetts, USA

Correspondence to Karen R. Boretsky, MD, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA. Tel: +1 617 355 6225; fax: +1 617 730 0894; e-mail:

© 2014 Lippincott Williams & Wilkins, Inc.