Current Concepts Review: The Use of Regional Anesthesia in Pediatric Orthopaedic Surgery

Abstract

The use of regional anesthesia in children undergoing surgery is not a new concept, having been pioneered in Europe at the turn of the 19th century. Although there was initial hesitation over potentially “doubling” the anesthetic exposure for children through the use of regional anesthesia in conjunction with general anesthesia, the idea of using regional anesthesia in the pediatric surgical population has gained considerable acceptance over the past 25 years. The term regional anesthesia encompasses a variety of techniques that may most simply be divided into central/neuraxial and peripheral blocks. Regional blocks may be administered through a single dose of anesthetic agent or as a continuous infusion through a temporary catheter. Nerve stimulation and ultrasonographic guidance are two commonly used techniques for the localization of nerves in regional anesthesia. Despite widespread concern over the risk of potentially devastating complications associated with regional anesthesia in the pediatric population, increasing data in the anesthesiology literature appear to demonstrate both its safety and efficacy for children undergoing surgical procedures, including orthopaedic surgery, although robust data in support of the value and quality of care that regional anesthesia permits for pediatric surgical patients are still lacking. Interdisciplinary studies of outcomes with the use of pediatric regional anesthesia, including both surgeons and anesthesiologists, may better inform this ongoing discussion.

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