Regional Anesthesia for Acute Pain Management

Regional anesthesia is frequently utilized to minimize pain during and after surgery, often reducing or even eliminating perioperative opioid requirements. One of the earliest descriptions of pediatric regional anesthesia was published in 1909, which discussed the role of subarachnoid blockade in children and infants. Over 100 years later, the field has evolved to include caudal epidural techniques, peripheral nerve blockade, and novel nerve blocks which target distal nerves. The proliferation of ultrasound utilization for performing regional anesthesia in pediatrics has contributed to its increased presence in perioperative pain management. Furthermore, recent Food and Drug Administration (FDA) warnings about the potential harms of exposing young children to general anesthetics have bolstered further interest in performing regional anesthesia, when appropriate, to minimize anesthetic requirements. Regional anesthesia has the potential to blunt the physiological response to surgical stimulation and can, at times, serve as a sole anesthetic. This chapter will provide an overview of regional anesthetic techniques that are commonly utilized in pediatrics. Indications, anatomy, potential complications, and available efficacy data will be addressed.