Regional Anesthesia in Pediatrics

Regional anesthesia for children has been described since the 19th century, but not until recently has it played such a central role in pediatric practice (see Chapter 45 ). There are multiple compelling reasons for its increasing use. The advantages include rapid, pain-free awakening; effective postoperative analgesia with long-acting local anesthetics; decreased incidence of nausea and vomiting; and faster onset time to oral intake.^[274] It is especially advantageous for premature infants and children with pulmonary medical conditions. The anesthesiologist must pay particular attention to total dose, site of injection, speed of injection, and use of vasoconstrictors, especially when performing a continuous regional technique.

It is more practical to administer regional anesthesia to children if they are sedated or anesthetized. This is very different from the standard of care for adults. However, the potential for an increased risk of neurologic injury has not been borne out in the pediatric literature.^{[274] [275]} Axillary, interscalene, combined spinal epidural and popliteal fossa blocks can be effectively used as the sole anesthetic or in combination with general anesthesia for most orthopedic extremity procedures. To safely administer these blocks to children, the anesthesiologist must be aware of the specific pharmacodynamic, physiologic, anatomic, and emotional differences in children.