Discuss the role of ultrasound-guided regional anaesthesia in paediatric practice. Summarise the acute postoperative benefits of regional anaesthesia and its role in chronic pain management. Identify the appropriate surgical indications for peripheral nerve blocks in children and their potential complications. Demonstrate the key anatomical aspects and technical steps for performing peripheral nerve blocks in children safely. Paediatric regional anaesthesia (RA) has become an integral part of the current paediatric anaesthetic care. Although Dalens had established the first paediatric RA teaching programme in France by the early 1980s, its scope in the paediatric anaesthetic practice has significantly expanded as a result of the recent enhancement in the ultrasound (US) image quality. 1 Despite the paucity of randomised controlled studies in paediatric compared with adults, evidence of the benefits of RA in children has started to emerge. 2 In infants, RA improves haemodynamic stability, reduces the incidence of postoperative respiratory complications, decreases catecholamine production and the metabolic stress response to surgery and promotes a fast return of gut function and feeding. 3 Studies in older children have also shown that RA reduces postoperative opioid consumption. 4e7 Updates from the latest North America Pediatric Regional Anesthesia Network (PRAN) registry of more than 100,000 nerve blocks showed that RA in children has an acceptable level of safety comparable with adult practice, with US technology progressively replacing nerve stimulator techniques and with the majority of nerve blocks being performed under general anaesthesia. 8 Neuraxial blocks are gradually abandoned in favour of single-shot or continuous peripheral nerve blocks (PNBs). This article briefly discusses the consent process for RA in children, and illustrates the clinical indications (Table 1) and technical aspects of the most common and less traditional single-injection US-guided peripheral limb nerve blocks and the indications for and management of continuous peripheral nerve catheters.
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