Regional Anesthesia and Pain Management in Ambulatory Pediatric Patients

During the past decade the majority of pediatric surgery has been performed in the ambulatory setting. The success of regional anesthetic and pain management techniques has played an important role in improving the quality of care for pediatric patients undergoing ambulatory surgery. Regional anesthesia in children is generally safe and effective. 29 Although regional anesthesia increases the complexity of anesthesia and requires additional time for obtaining informed consent from parents, the initial time investment is justified. Two major advantages of regional anesthesia include reduced general anesthesia requirement and optimal postoperative analgesia. Regional anesthesia can be used as the sole anesthetic or combined with general anesthesia. If combined with general anesthesia, regional anesthesia decreases the need for the general anesthetic agent, resulting in faster emergence and return to an alert mental status, earlier ambulation, and earlier discharge. 30 Furthermore, regional anesthesia optimizes postoperative analgesia. Pietropaoli et al 27 reported that regional anesthesia eliminated the need for systemic narcotics in the majority of 174 children who underwent major surgical procedures. The reduced need for parenteral opiates decreases associated side effects, including nausea and vomiting.