The Use of Regional Anesthesia in Pediatric Orthopaedic Surgery—Review of the Literature, Controversies, and Current Status

Regional anesthesia (RA) has become an increasingly important component of perioperative care in pediatric orthopaedic surgery. RA utilization in pediatric patients is well documented as part of the management of upper and lower extremity trauma, both at the time of fracture reduction as well as during definitive surgical stabilization. Elective management of both upper and lower extremity deformities and reconstruction of chronic injuries with RA support are common practices in many centers. Use of RA to mitigate postoperative pain and improve patient mobilization after elective spinal deformity procedures in pediatric patients is also well established. Despite extensive studies reporting successful and safe use of RA in his patient cohort, questions remain regarding potential risks and complications, particularly potential issues with postprocedure neurologic evaluation. Continued modifications in anesthetic techniques, in combination with an increased use of peripheral nerve blocks in place of neuroaxial blockades, may further limit the risk of potential postoperative issues.