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Anatomical Studies Evaluating Pediatric Regional Anesthesia: A Scoping Review
Lucas Ferreira Gomes Pereira1, Ricardo Vieira Carlos1,2, Albert van Schoor3
1Discipline of Anesthesiology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-010, Brazil.
Insights
This review highlights the need for more anatomical studies in pediatric regional anesthesia. Evidence from cadaver studies is scarce, impacting the safe application of nerve blocks in children.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Anatomy
Background:
- Pediatric regional anesthesia is increasingly used to spare opioids and avoid general anesthetic neurodevelopmental risks.
- Performing pediatric regional anesthesia studies is challenging, leading to limited evidence.
- Concerns exist regarding local anesthetic dispersion and absorption in children.
Purpose of the Study:
- To review the scientific foundation of cadaver studies assessing pediatric regional anesthesia techniques.
- To identify existing anatomical research relevant to pediatric nerve blocks.
Main Methods:
- Searched MEDLINE, EMBASE, and Web of Science databases.
- Included anatomical cadaver studies evaluating peripheral nerve blocks in children.
- Collected data on block type, evaluation, results, and conclusions.
Main Results:
- Identified 16 relevant anatomical studies out of 2409 initial results.
- Evaluated various pediatric nerve block techniques, including erector spinae plane, ilioinguinal/iliohypogastric, sciatic, and femoral nerve blocks.
- Cataloged specific block types assessed in pediatric cadaver studies.
Conclusions:
- While regional anesthesia is common in children, a lack of anatomical studies creates uncertainty.
- Further anatomical research is crucial to guide and improve pediatric regional anesthesia practices.
- Cadaver studies provide a foundation for understanding nerve block application in pediatric populations.
Background:
Pediatric regional anesthesia has been driven by the gradual rise in the adoption of opioid-sparing strategies and the growing concern over the possible adverse effects of general anesthetics on neurodevelopment. Nonetheless, performing regional anesthesia studies in a pediatric population is challenging and accounts for the scarce evidence. This study aimed to review the scientific foundation of studies in cadavers to assess regional anesthesia techniques in children.
Methods:
We searched the following databases MEDLINE, EMBASE, and Web of Science. We included anatomical cadaver studies assessing peripheral nerve blocks in children. The core data collected from studies were included in tables and comprised block type, block evaluation, results, and conclusion.
Results:
The search identified 2409 studies, of which, 16 were anatomical studies on the pediatric population. The techniques evaluated were the erector spinae plane block, ilioinguinal/iliohypogastric nerve block, sciatic nerve block, maxillary nerve block, paravertebral block, femoral nerve block, radial nerve block, greater occipital nerve block, infraclavicular brachial plexus block, and infraorbital nerve block.
Conclusion:
Regional anesthesia techniques are commonly performed in children, but the lack of anatomical studies may result in reservations regarding the dispersion and absorption of local anesthetics. Further anatomical research on pediatric regional anesthesia may guide the practice.
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