Paediatric regional anaesthesia: a current perspective

Effective analgesia is necessary for optimal recovery after surgery, but children often do not attain adequate postoperative pain control. This review examines the current trends in paediatric regional anaesthesia.

Better pain assessment and therapeutic regimens are needed for our patients. Trunk blocks such as paravertebral, transversus abdominis plane, rectus sheath and ilioinguinal/iliohypogastric are becoming a popular means of providing analgesia for thoracic and abdominal procedures. The introduction of ultrasound guidance improves accuracy, efficacy, and safety of regional anaesthesia, and also decreases the amount of local anaesthetic injected. Single injection nerve blocks have a limited duration and the patients can benefit from adding an adjunct to local anaesthetic or placing a catheter. The use of adjuncts is reasonable, but it is difficult to find a medication with both minimal side-effects and the ability to combat pain for extended periods of time. More peripheral nerve block catheters are used in the paediatric inpatient and outpatient settings and recent data support the feasibility and efficacy of ambulatory peripheral nerve catheters.

By using a multimodal approach that includes regional anaesthesia, paediatric pain management should aim to reduce patients' pain to an acceptable level without compromising their degree of mobilization. Undoubtedly, peripheral nerve blocks improve analgesia, but future large prospective studies should be conducted to further delineate their effectiveness, duration and safety.