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Current controversies in paediatric regional anaesthesia

Sarah Jackson1, Zoe Burton2, Annabel Pearson1

  • 1Department of Anaesthesia, Bristol Royal Hospital for Children, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol.

Current Opinion in Anaesthesiology
|March 26, 2026
PubMed

Insights

Regional anesthesia offers safe and effective pain management for children, with low complication rates. Emerging evidence supports its use with additives and in enhanced recovery protocols, even in neonates.

Area of Science:

  • Pediatric Anesthesiology
  • Pain Management
  • Regional Anesthesia Techniques

Background:

  • Regional anesthesia is crucial for pediatric perioperative care and acute pain management.
  • Current practices involve local anesthetic additives and peripheral nerve catheters for prolonged analgesia.
  • Enhanced Recovery After Surgery (ERAS) protocols increasingly incorporate regional anesthesia.

Purpose of the Study:

  • To explore current controversies and emerging evidence in pediatric regional anesthesia.
  • To review the safety and efficacy of local anesthetic dosing and additives in children.
  • To assess the role of regional anesthesia in ERAS and awake procedures.

Main Methods:

  • Review of current literature on pediatric regional anesthesia.
  • Analysis of safety data regarding local anesthetic systemic toxicity (LAST) and additives.
  • Evaluation of evidence supporting ultrasound-guided techniques and awake regional anesthesia.

Main Results:

  • Dosing of local anesthetics in children, especially neonates, remains a point of controversy.
  • Additives like dexamethasone, dexmedetomidine, and clonidine are effective but optimal administration routes are debated.
  • Peripheral nerve catheters are safe for ambulatory settings, and regional anesthesia is compatible with ERAS.
  • Fear of masking compartment syndrome is not a contraindication; awake regional anesthesia can avoid general anesthesia.
  • Ultrasound-guided regional anesthesia proficiency is increasingly vital in anesthetic training.

Conclusions:

  • Regional anesthesia is a safe and effective analgesic option for pediatric patients, including trauma cases and ERAS protocols.
  • Evidence supports the use of additives, with generally low complication rates, including LAST.
  • Advancements in techniques and understanding continue to expand the utility of regional anesthesia in children.
Abstract

Keywords:
enhanced recoverylocal anaesthetic systemic toxicitypaediatric anaesthesiaperipheral nerve cathetersregional anaesthesia

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