Ultrasound Guided Neuraxial Block in Pediatric Patients

Abstract

Pediatric regional anesthesia (PRA) has today reached widespread useand become more popular, supported by reassuring data from the international literature showing the safety and efficacy of this technique. The benefits of regional techniques include avoidance of perioperative opioids and their associated side effects, early ambulation, and excellent pain control, with the absence ofadverse side effects including postoperative nausea and vomiting, have increased their use in this age group. Combined regional and general anesthesia may actually improve outcome and thereby decrease hospital stay. Though 89% of the blocks were performed under sedation/anesthesia, only 0.9/1000 complications occurred, with no deaths and no sequelae, comparing favorably with similar surveys in adults, showing that PRA is at least as safe as RA in awake adult patient In recent years, anatomically based ultrasound is one of the most exciting advances in technology in relation to pediatric regional anesthesia. The use of ultrasound in neuraxial anesthesia in adults is somewhat limited because of the reduced visibility of the spinal canal resulting from poor ultrasound beam penetration through the ossified bony vertebral column. In theory, ultrasound could be of much greater value in the young pediatric population where there is limited ossification, thus allowing good visual resolution of the anatomy and block-related equipment or solutions.