THE USE OF REGIONAL BLOCKS in pediatric anesthesia has increased dramatically with the advent of ultrasound guidance. However, nerve blocks still tend to be underutilized in children. This can be attributed to fear of neurologic complications, lack of experience, or lack of appropriate pediatric-sized equipment. In pediatric patients, it is standard to perform regional blocks under general anesthesia. The benefit of successful regional anesthesia lies in a more comfortable emergence. In turn, this reduces complications associated with parenteral opioids in vulnerable pediatric patients (neonates, ex-premature infants, and children with cystic fibrosis).

Although regional blocks confer similar advantages in children as in adults, the methods used for performing these techniques must be modified. Expectedly, the key to success lies in knowledge of anatomy, pharmacology, equipment, ultrasound, and preblock sedation or anesthesia. Because general anesthesia/sedation is often required, two individuals are helpful; one to perform the block and the other to monitor the child. All techniques, whether regional or general, carry risks, and the latter must be weighed against the potential benefits in anesthetized children. The current chapter focuses on how pediatric regional techniques differ from their adult counterparts. There exist excellent reviews of pediatric regional anesthetic techniques for readers who wish to pursue the latter in more detail (1,2,3,4).