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Perspectives in Pediatric Ambulatory Anesthesia: Part 3-One Center's Evolving Regional Anesthesia Experience and

David E Liston1, Elizabeth E Hansen1, Jennifer L Chiem1

  • 1Department of Anesthesiology & Pain Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA.

Paediatric Anaesthesia
|July 9, 2026
PubMed

Insights

Pediatric regional anesthesia (RA) use shifted towards peripheral nerve blocks with ultrasound guidance, decreasing central neuraxial blocks and improving anesthesia preparation times and patient outcomes.

Area of Science:

  • Anesthesiology
  • Pediatric Surgery
  • Regional Anesthesia

Background:

  • Pediatric ambulatory surgery is the primary surgical care model in the U.S.
  • Regional anesthesia (RA) use has expanded in pediatrics, particularly with ultrasound guidance.
  • This study examines RA practice changes over 14 years in a pediatric ambulatory surgery center.

Purpose of the Study:

  • To document changes in pediatric regional anesthesia practice over a 14-year period.
  • To assess the impact of ultrasound and other factors on RA techniques.
  • To evaluate the effect of RA practice evolution on clinical outcomes.

Main Methods:

  • Retrospective review of RA practices from July 2010 to December 2024.
  • Utilized de-identified health data from an EMR system.
  • Applied statistical process control methods to analyze practice variations.

Main Results:

  • Peripheral nerve block (PNB) incidence increased from 13% to 35.4%, associated with ultrasound.
  • Central neuraxial block (CNB) incidence decreased from 10% to 2%.
  • Anesthesia preparation time decreased; first-attempt RA success rates remained high.
  • PACU pain and opioid use decreased for both RA and non-RA patients.

Conclusions:

  • Pediatric RA practice has evolved, with increased PNBs and decreased CNBs.
  • These practice changes, coupled with opioid-sparing strategies, improved clinical outcomes.
  • Findings reflect practice at a specific pediatric ASC and may not be generalizable.
Abstract

Keywords:
ambulatory surgerypediatric anesthesiaquality improvementregional anesthesiasafety

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