Peripheral Regional Anesthesia Techniques in Pediatric Cardiac Surgery: A Scoping Review

Peripheral regional anesthesia (PRA) techniques have gained increasing attention as adjuncts to multimodal analgesia and enhanced recovery pathways. This scoping review aims to summarize the current evidence on the use of PRA in pediatric patients undergoing cardiac surgery and seeks to inform clinical practice by answering 10 predetermined research questions. This scoping review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews guidelines. We searched 6 databases and trial registries up to August 2025. Eligible studies were randomized controlled trials of patients aged <18 years undergoing cardiac surgery under general anesthesia, with interventions involving PRA, published in English. We also performed a post hoc screening to identify evidence synthesis studies relevant to the current scoping review. We extracted and qualitatively synthesized data on block techniques, perioperative outcomes, and PRA-related complications. Twenty-nine randomized controlled trials were eligible, in which 11 PRA techniques were reported. The post hoc screening identified 5 systematic reviews with meta-analysis. Compared with placebo, PRA was associated with reduced intraoperative and postoperative opioid consumption, shorter time to extubation, decreased intensive care unit length of stay, and lower pain scores at 8 to 24 hours postoperatively in most studies. PRA-related complications, such as pneumothorax or block failure, were rare, and the incidence was not different from placebo. Trials comparing the PRA techniques were limited, and the findings were inconclusive. In conclusion, PRA techniques improve perioperative outcomes in pediatric cardiac surgery, including opioid sparing, earlier extubation, and shorter intensive care unit stay, with a favorable safety profile. The results are descriptive, and further trials are needed to standardize dosing and optimize block selection.