Regional and Local Anesthesia in Pediatric Orthopaedic Surgery

Abstract

Pediatric orthopaedic surgical procedures require a thoughtful multimodal approach to perioperative pain management that maximizes both patient comfort and safety. Local infiltrative anesthesia (LIA) provides limited anatomic coverage over a relatively short length of time. In comparison, regional anesthesia can provide increased anatomic coverage over a longer duration by applying anesthetic medication directly around a targeted peripheral nerve or nerves. Peripheral nerve blocks (PNB) are commonly used in pediatric and adolescent sports medicine procedures, especially for anterior cruciate ligament reconstructions (ACLR). Yet there remains a wide variation in how PNBs are performed with limited evidence in support of their overall benefits in children relative to potential complications, such as prolonged sensory or motor nerve paralysis. Even less is known about their use and indications for a variety of non-sports pediatric orthopaedic procedures. This article provides a review on the uses and indications of both local and regional anesthesia in pediatric orthopaedics with a discussion on the available evidence in the literature on safety and efficacy. Key Concepts• The use of PNBs in the pediatric population has been increasing, especially for ACLR procedures.• PNBs can result in improved immediate postoperative analgesia, but they have not been shown to significantly decrease overall postoperative opioid consumption.• PNBs have a higher risk profile than LIA, and the incidence and long-term significance of these risks has not been sufficiently studied.• The use of ultrasonography improves the safety and effectiveness of PNBs.