New Concepts and Techniques in Pediatric Anesthesia 0889–8537/02 $16.00 .00 Practical Pediatric Regional Anesthesia

Regional anesthetic techniques in children have become more popular in the past decade. This is in part because of recent research indicating biobehavioral changes associated with untreated pain in children.2, 86 Most regional techniques in children are performed under heavy sedation or general anesthesia. Concerns regarding safety and the medicolegal liability of performing regional blocks under anesthesia must be weighed against the trauma and potential danger of placing blocks in awake, uncooperative children. A large body of clinical experience supports the safety and efficacy of regional blocks placed under general anesthesia in children.49 There is evidence-based literature to show that combined regional and general anesthesia may actually improve outcome and thereby decrease hospital stay.61 The availability of better equipment and safer local anesthetic agents has also improved the safety of regional anesthetic techniques. Overall, the incidence of complications with the use of regional techniques in children is not significantly different from that in the adult population. The benefits of regional techniques include avoidance of perioperative opioids and their associated side effects,84 early ambulation, and excellent pain control. The preemptive