Peripheral nerve blocks in pediatric anesthesia

INTRODUCTION: Most children undergoing surgery can benefit from regional anaesthetic techniques, either as the sole anaesthetic regimen or, as usual in paediatric practice, in combination with general anaesthesia. The use of peripheral nerve blocks (PNBs) in paediatric anaesthesia is an effective way to decrease the side-effects and complications associated with central blocks. In spite of their many advantages, including easy performance end efficacy, peripheral nerve blocks are still underused. OBJECTIVE: This article discusses a general approach to PNBs in children and provides data concerning the practice of this regional technique in different age groups. METHODS: Data from 1,650 procedures were prospectively collected during the period from March 1, 2007 to February 29, 2008. The type of PNB, if any, as well as the patient age were noted. Our patients were divided into four groups: 0-3 years, 4-7 years, 8-12 years and 13-18 years. RESULTS: During the investigated period, PNBs as a sole technique or in anaesthetized children were performed in 7.45% of cases. Ilioinguinal/iliohypogastric nerve block and penile block were the most common (70% of all PNBs) distributed mainly among the children between 4-7 years of age (p < 0.05). In older children, extremity PNBs predominate in regard to other types of blocks. PNBs are most frequently performed under general anaesthesia (85%), so the perineural approach requires a safe technique to avoid nerve damage. CONCLUSION: The observed differences in PNB usage seem to be related to patient age and correlate with common pathology and also with technical availability of PNB performance.