Paediatric Regional Anaesthesia: Current Evidence, Techniques and Evolving Standards of Care

Abstract

AbstractPaediatric regional anaesthesia has evolved over the years with regional anaesthesia playing a vital role in perioperative pain management in children. Regional anaesthesia (RA) provides targeted analgesia in children while minimising systemic side effects and side effects associated with systemic opioid use. The Ultrasound which is now the standard of care has also revolutionised this area enabling real time visualisation of nerves and local anaesthetic spread. This enhances precision and safety reducing the incidence of complications like Local anaesthetic systemic toxicity (LAST). Common RA techniques include neuraxial blocks (e.g., caudal and epidural) and a diverse array of peripheral nerve and fascial plane blocks (e.g., TAP, ESP, and rectus sheath blocks) utilising modern, safer local anaesthetics (ropivacaine and levobupivacaine), and adjuvants (clonidine, ketamine, dexmedetomidine) to prolong analgesia. Integrating RA into Enhanced Recovery After Surgery (ERAS) protocols promotes faster recovery, and is crucial for achieving opioid-sparing analgesia. Ongoing research, including the findings of the GAS trial regarding neurodevelopmental safety, continues to support the benefits and efficacy of these techniques, cementing paediatric regional anaesthesia as a fundamental component of high-quality surgical care.