Regional Anesthesia in Children: How Do We Know It Works? A Review of a Novel Tool for Assessing the Impact of Regional Anesthesia for Pediatric Surgical Patients

Objectives: We wished to demonstrate the utility of a novel quantitative assessment tool for the efficacy of regional anesthesia in children. Methods: The authors examined the records of all patients evaluated by the acute pain service during a 6-month period at a large quaternary-care pediatric hospital. The morphine equivalency rate (MER) in mcg/kg/hour was employed to compare the opioid use in children undergoing similar procedures with and without regional anesthesia (RA). Results: A total of 744 patients were included in this study, 333 of whom received RA. The RA group demonstrated a statistical and clinical benefit from having regional anesthesia, as demonstrated by the MER, compared to the non-RA group. Discussion: Objective measurements of RA in adults are overshadowed by subjective evidence of surgical tolerance in awake or lightly sedated patients. However, in pediatrics, objective measures are still needed to highlight the importance and utility of RA. Such objective tools could impact the adoption of RA by our surgical colleagues and have a long-term impact on opioid use and even abuse. We implemented the MER to quantify the benefit of RA. Given the adverse effects of opioids on gut motility, the incidence of nausea and vomiting, hypersensitivity reactions, and ubiquitous potential for abuse, the MER objectively demonstrates RA’s impact on pediatric surgical patients and why its utilization as an assessment tool could ultimately change practice.