Regional Anesthesia in Children; Beyond the Caudal Block

Abstract

Pediatric regional anesthesia has gone through significant development in recent years with advances in safety information, pharmacology, and block techniques. There is an increasing interest in regional anesthesia in pediatrics beyond the common caudal, epidural, or spinal. With improvements in equipment that are specific to children and the addition of ropivacaine as a proven local anesthetic, pediatric regional anesthesia, and specifically peripheral nerve blockade, should continue to gain popularity (Allison et al.; 2008). Epidural analgesia has many beneficial effects in the pediatric patient population. In clinical practice, it is commonly used to augment general anesthesia and to manage postoperative pain. Effective postoperative pain relief from epidural analgesia has numerous benefits including earlier ambulation, rapid weaning from ventilators, reduced time spent in a catabolic state and lowered circulating stress hormone levels. Precise placement of epidural needles and catheters for single-shot and continuous epidural anesthesia ensures that the dermatomes involved in the surgical procedure are selectively blocked, allowing for lower doses of local anesthetics and sparing of unnecessary blockade in the regions where blockade is not desired (Henderson et al.; 2008).