Current controversies in paediatric regional anaesthesia.

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.