229. Regional Anesthesia

Question 1

What are the key differences between pediatric and adult regional anesthesia procedures?

Answer 1

Differences include differing neurocognitive states, anatomy, physiology, and pharmacodynamics

Pediatric regional techniques leave little room for error, and dosing of local anesthetics is closer to the toxic threshold.

Question 2

What are the benefits of regional anesthesia in pediatric patients?

Answer 2

Benefits include improved postoperative analgesia, improved postoperative respiratory function, decreased intraoperative anesthetic requirements, and decreased opioid requirements.

Question 3

Why is general anesthesia often used in pediatric patients prior to block placement?

Answer 3

Many children and infants will not tolerate awake procedures.

Question 4

What is the role of ultrasound guidance in pediatric regional anesthesia?

Answer 4

Ultrasound allows direct visualization of anatomical structures and the deposition or spread of local anesthetic, improving block success and dosing.

Question 5

What are common contraindications to regional block placement in pediatric patients?

Answer 5

• Infection at the block site
• Coagulopathy
• Anatomical difficulty or congenital anomaly
• Sepsis (particularly if neuraxial)

Question 6

How do decreased levels of α1-glycoprotein affect local anesthetics in pediatric patients?

Answer 6

Decreased levels result in decreased protein binding of local anesthetics, increasing toxicity risk.

Question 7

What is the maximum allowable dose of bupivacaine in pediatric patients?

Answer 7

2.5 mg/kg.

Question 8

What is the maximum allowable dose of ropivacaine in pediatric patients?

Answer 8

3 mg/kg.

Question 9

What should be done if local anesthetic systemic toxicity is suspected?

Answer 9

Give an initial bolus of intralipid of 1.5 mL/kg over 1 minute and start infusion of intralipid at 15 mL/kg/h.

Question 10

What is the primary use of a pediatric spinal or subarachnoid block?

Answer 10

Primarily used in infants undergoing urological or hernia surgery.

Question 11

What is the conus medullaris level in infants compared to adults?

Answer 11

The conus medullaris lies lower in infants (L3) compared to adults (L1).

Question 12

What is the most common block performed in pediatric patients?

Answer 12

Caudal anesthesia.

Question 13

What is the typical volume range recommended for caudal injection in pediatric patients?

Answer 13

Between 0.5 and 1 mL/kg.

Question 14

What does a test dose for caudal anesthesia include?

Answer 14

Both local anesthetic and epinephrine.

Question 15

What is the most commonly performed upper extremity block in pediatric patients?

Answer 15

Supraclavicular block.

Question 16

What are truncal blocks, and why are they gaining favor in pediatric patients?

Answer 16

Truncal blocks (e.g., quadratus lumborum, erector spinae) are gaining favor due to ease of placement and longer duration of analgesia.

Question 17

What is the purpose of the rectus sheath block?

Answer 17

Used for umbilical hernia procedures and blocks T9-11 intercostal nerves.

Question 18

What role does regional anesthesia play in enhanced recovery after surgery protocols?

Answer 18

Regional anesthesia is a key component along with multimodal analgesia, early mobilization, and optimization of nutrition.