Update In Central Neuraxial Blockade In Pediatrics

Regional block procedures have gained an established place in pediatric anesthesia, especially for outpatient surgery and postoperative pain relief. This increasing interest results from technical improvements, including the use of nerve stimulators for precise location of nerve trunks and the availability of equipment designed specifically for children.This greater acceptance and use of regional procedures in pediatrics are also a consequence of better understanding of the basic anatomic, physiologic, and pharmacologically relevant differences between children and adults, as well as a broader definition of anesthesia in which general and regional procedures are considered complementary to one another rather than being exclusive.The selection of an anesthetic procedure, either general, regional, or a combination of both, is made on a case-by-case evaluation of what is best for a given patient and reflects the ability of the anesthesiologist to make sound judgments about the technique that will provide the greatest comfort and safety to the patient.Ultrasonography is a very valuable tool for inserting epidural catheters in anesthetized children. Relevant anatomical structures and their location and the corresponding depth can be identified. Additional injection of medications into the epidural space can be visualized. The addition of this real-time procedure makes the insertion of epidural catheters in children easier.Direct visualization of the intraepidural spread of local anesthetic is a reliable way to verify the position of the epidural catheter. In experienced hands, ultrasound guidance reduces both the duration of catheter placement and the risk of bone contacts.