Can regional techniques be used for children?
Regional techniques for the administration of local anesthetics and other analgesics are an integral part of postoperative pain management. For example, a one-shot caudal may prevent the need for outpatient analgesics after hernia repair, local anesthetic catheters may prevent the need for epidural analgesia and facilitate transition home after major postoperative procedures, and Bier blocks may facilitate fracture reduction. The only absolute contraindication to catheter placement is the inability to place the catheter—for example, in children with myelomeningocele. Epidurals or spinal analgesia are recommended for the management of postoperative pain in patients undergoing thoracic, abdominal, hip, and lower extremity procedures. Catheters can be placed caudally and advanced under ultrasound guidance to achieve thoracic level analgesia (e.g., for newborns requiring cardiac surgery). There are no absolute limits for length of time the catheter can remain in the epidural space, but if longer duration is anticipated, the catheter should be tunneled. Catheters should be immediately assessed and removal considered if a child becomes septic (due to risk of catheter seeding), is at great risk of bleeding (due to risk of epidural hematoma), exhibits a new motor block (potential epidural hematoma), or the catheter is no longer functional or needed. Children who have received regional anesthetic techniques should be monitored for these adverse effects, and these techniques should only be used in settings where health care providers have adequate training in these techniques, have early recognition of adverse effects, and are prepared to rapidly treat adverse effects from regional anesthesia.