There is evidence that regional blocks are advantageous in pediatric surgical operations, but which blocks should one use and under what circumstances? In children safety is the absolute priority, therefore in choosing the best technique for a particular procedure in a child, the anesthetist should prefer the safest one. In 1996 Giaufré et al. reported the result of a prospective study on the practice of pediatric regional anesthesia by the Association des Anesthesistes Reanimateurs Pediatriques d’Expression Francaise. Data from 24,409 regional blocks were collected. Of 15,013 central blocks, 23 complications were reported, whereas of 9,396 peripheral blocks, no complications were reported. In cases in which it is possible to use either a central or a peripheral nerve block, we must remember the advantages of using a peripheral nerve block such as major safety, no urinary retention, longer duration, less need for postoperative analgesia, possible in patients with coagulation problems, and limitation of the area of analgesia to the surgical field. On the contrary the disadvantages are few: major technical demand, larger volume of anesthetic solution requested, longer onset time. Basically, whenever appropriate, a peripheral nerve block is preferable to an axial block. Many of the peripheral blocks are in fact safe, simple, easy to perform, and effective. The use of a nerve stimulator, when appropriate, greatly increases the success rate of some of these blocks.

All the variety of peripheral nerve blocks used in adults can be used in pediatrics. The commonly performed peripheral blocks in children are the brachial plexus block (parascalene or axillary) for forearm and hand surgery and for revascularization; the femoral nerve block for femoral fractures, femoral osteotomies, and quadriceps muscle biopsy; the fascia iliaca block with the same indications as for the femoral nerve block plus knee surgery; the sciatic nerve block with the lateral approach at the trochanter level for fibular osteotomy, club foot repair, and the remove of plantar foreign bodies; and the sciatic nerve block with the lateral approach at the popliteal level for tibial osteotomy or ankle fractures.