Regional Anesthesia

Abstract

Abstract Many differences exist between pediatric and adult regional anesthesia, including differing neurocognitive states, anatomy, physiology, and pharmacodynamics. In pediatric patients, regional procedures are performed under general anesthesia; many children cannot tolerate the placement of an awake block. Infant spine anatomy involves a low-lying conus medullaris and an increased volume of cerebral spinal fluid per kilogram with rapid turnover. These differences affect both block placement and duration. Physiologically, infants and children undergoing neuraxial procedures tolerate sympathetic blockade, and blood pressure remains preserved. Pharmacodynamics are affected by decreased levels of α1-glycoprotein, which result in decreased protein binding of local anesthetics and can increase toxicity risk. Despite these challenging differences, pediatric regional anesthesia can result in improved postoperative analgesia, decreased intraoperative anesthetic requirements, and decreased opioid requirements.