Regional Anesthesia

Regional anesthesia has become an integral and common component of both intraoperative anesthesia and postoperative analgesia in infants and children. Advantages of regional blockade include the reduction of general anesthetic dose requirements, effective blunting of hemodynamic and autonomic responses, and excellent postoperative analgesia with decreased requirement of systemic analgesics and their concomitant side effects. For many orthopedic operations, increasing use of peripheral nerve blockade permits the anesthesiologist to provide long durations of analgesia limited to the surgical site. Spinal anesthesia in infants has been demonstrated to be an effective alternative to general anesthesia for subumbilical operations lasting an hour or less. However, the risks of local anesthetic toxicity may be magnified in infants and children because of their size and immaturity, and great care and precision must be used when choosing volume and concentration. Because the vast majority of regional blocks in children are performed with patients under general anesthesia, early signs of toxicity are usually obscured. The emergence of lipid emulsion therapy for local anesthetic systemic toxicity has dramatically altered our approach and the successful outcome to these events and should be administered promptly. Large-scale prospective data from multicenter collaborative studies have documented that regional anesthetics in children have a high degree of safety, and prospective data have confirmed that administering blocks to children under general anesthesia confers no increased risk of injury. While one must have specific technical skills, as well as an understanding of the differences in pediatric physiology, anatomy, and pharmacology, to use regional blockade in infants and children, the benefits of these techniques are great.