Fascial plane blocks in children: Mechanisms, indications, controversies, and practical guidance: A narrative review

Area of Science:

• Pediatric Anesthesiology
• Regional Anesthesia
• Pain Management

Background:

• Fascial plane blocks (FPBs) are increasingly used in pediatric surgery for thoracic, abdominal, and lower-extremity procedures.
• Despite reported benefits, controversy persists due to inconsistent nomenclature, dosing, spread, and comparator choices (e.g., neuraxial vs. peripheral blocks).

Purpose of the Study:

• To synthesize current pediatric evidence on various fascial plane blocks.
• To highlight pediatric-specific anatomical and physiological considerations.
• To appraise safety, including local anesthetic systemic toxicity, and catheter techniques, while identifying research priorities.

Main Methods:

• Systematic review of current pediatric data on fascial plane blocks.
• Inclusion of evidence from narrative reviews, randomized controlled trials, and meta-analyses.
• Focus on specific blocks: serratus anterior plane, erector spinae plane, rectus sheath, transversus abdominal plane, quadratus lumborum, fascia iliaca, and adductor canal blocks.

Main Results:

• The review synthesizes data on thoracic, abdominal, and lower-extremity fascial plane blocks in children.
• It addresses pediatric anatomical and physiological nuances relevant to block performance and safety.
• Safety aspects, including local anesthetic systemic toxicity and catheter use, are evaluated.

Conclusions:

• Fascial plane blocks are a growing area in pediatric regional anesthesia, offering potential benefits across various surgical sites.
• Standardization of nomenclature, dosing, and comparative studies are crucial to resolve ongoing controversies.
• Further research is needed to optimize safety and efficacy, addressing identified limitations and research priorities.