Pediatric Regional Anesthesia

Regional anesthesia is a type of pain management technique that anesthetizes or numbs a specific part of the body.  This is typically accomplished by injecting numbing medicine near the nerves that supply sensation to the desired part of the body. Regional anesthesia includes nerve blocks, epidurals and spinals.  In pediatric patients regional anesthesia is typically performed while they are sedated or under general anesthesia.

Regional anesthesia has been safely performed in pediatric patients for many years at institutions around the world. All procedures carry a level of risk. One of our board-certified pediatric anesthesiologists will discuss the risks and benefits specific to your child on or before the day of surgery. One of the differences for pediatric patients as compared to adult patients is that regional anesthesia blocks are typically performed under sedation or general anesthesia. The safety of this practice has been confirmed with data from the Pediatric Regional Anesthesia Network (PRAN). The PRAN network was established in 2007 to study regional anesthesia in infants and children. It has grown to include 21 centers with data from over 100,000 pediatric patients. This database provides benchmarking data for practitioners across North America and around the world.

In pediatric patients, regional anesthesia is typically performed when they are sedated or under general anesthesia. Most commonly this is accomplished during the same time your child is under general anesthesia for their surgery. The safety of this practice has been confirmed with data from the Pediatric Regional Anesthesia Network (PRAN). The PRAN network was established in 2007 to study regional anesthesia in infants and children. It has grown to include 21 centers with data from over 100,000 pediatric patients. This database provides benchmarking data for practitioners across North America and around the world.

A nerve block is performed by injecting numbing medicine near a nerve to block pain in a specific part of the body. This can be performed as a single injection or a small catheter can be left in place. The catheter is then used to administer numbing medicine during and after surgery. Nerve block catheters can be left in place for about 3-5 days depending on the location and type of procedure performed.

An epidural is a type of regional anesthesia where medication is injected into the epidural space. This differs from a spinal block where medication is injected into the spinal space. An epidural can be performed as a single injection or a small catheter can be left in place. The catheter is used to administer medicine during and after the surgery to keep the patient as comfortable as possible.  A common type of single-injection epidural block performed in pediatric patients is a caudal block.

A caudal block is a type of regional anesthesia where medicine is injected into the caudal space. This is a type of epidural block that takes advantage of the unique anatomy of babies and toddlers, the sacral hiatus. The sacral hiatus is an opening in the tailbone formed by the incomplete fusion of the sacral vertebrae. This block is most often performed as a single injection but a small catheter can be left in place to continue the administration of pain medication.

A spinal block, also called a subarachnoid block, is a type of regional anesthesia where medication is injected around the spinal cord. This is typically a single injection and no catheter is left in the patient.

Most pediatric regional anesthesia is performed with a single injection of medicine that can last anywhere from a few hours to a few days. As an example, for surgery on the foot, a regional nerve block can be performed that numbs the entire foot. The pain can be reduced to a level that the patient may prematurely walk on the foot. Caution must be observed to avoid any secondary injuries from premature use of the surgical area. This will all be discussed with you on the day of the procedure. Sometimes a catheter is left in place to deliver pain medicine for a few days. We also have specialized catheters and delivery systems that allow patients to go home and continue to utilize the nerve block to remain as comfortable as possible. We are dedicated to keeping your child comfortable and safe. While in the hospital a member of our acute pain service will see and evaluate your child each day. The acute pain service is available 24 hours a day, 7 days a week.

The use of point of care ultrasound (POCUS) has become ubiquitous in the anesthesia field. We utilize the most current ultrasound (non x-ray) technology to perform most regional anesthesia procedures. At times, x-rays are used to confirm appropriate anatomical placement.