الفهرس 
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Abstract
One of the most exciting cent advances in technology in pediatric regional anesthesia has been the introduction of anatomically based ultrasound imaging for facilitating nerve localization. This is because regional anesthesia techniques in children have been considered challenging due to targeting neural structures that often course very close to critical structures (e.g., nerves of the brachial plexus run close to the pleura as they traverse the supraclavicular region)
Pediatric regional anesthesia is commonly used in adjunction with general anesthesia and plays a key role in the multimodal approach of pain management in surgical and nonsurgical pediatric patients and provides excellent postoperative analgesia. The development of needles and catheters for pediatric patients has made the use of these techniques easier and safer. Large retrospective and prospective studies confirm the infrequent rate of complications and no major sequelae with regional anesthesia in children, especially with peripheral nerve blocks. The use of long-acting local anesthetics with less cardiotoxicity, as well as ropivacaine or levobupivacaine, increases the safety of these procedures in children. Virtually all techniques of nerve blockade have been evaluated in pediatrics, thus allowing precise definition of their indications, contraindications, and adverse effects.
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Safe dosing guidelines and age-related trends in local anaesthetic pharmacokinetics and pharmacodynamics have been characterized and have facilitated expansion of paediatric re- gional anaesthesia practice.
Resuscitation measures must be initiated immediately after local anaethetic systemic toxicity (LAST). Neurotoxicity (seizures) can be treated with barbiturates, benzodiazapines or propopfol. Recent evidence indicates that the most successful treatment for LAST-related cardiotoxicity is the administration of a lipid emulsion, which is now considered first line therapy.
Pediatric regional anesthesia has attained wide use internationally because of its efficacy and safety. Safer drugs and dedicated pediatric tools are the keys to this success. This is so despite the fact that general anesthesia is necessary in most children for the regional block to be performed easily, safely, and effectively. Indeed, placement of regional blocks of all types under general anesthesia is considered the standard of care in pediatrics.
Increased use of regional anaesthesia in infants, children, and adolescents has significantly improved the scope of paediatric pain management. Regional anaesthesia is generally accepted as an integral component of postoperative pain relief in paediatric patients.
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Caudal block is one of the most commonly used paediatric regional anaesthetic techniques for postoperative analgesia. Caudal block is performed in children undergoing surgery of the lumbosacral to midthoracic dermatomal levels with anticipated moderate to severe postoperative pain.
Peripheral and truncal nerve blocks are playing an emerging role in pediatric postoperative pain management .Several peripheral blocks have also been described as effective in achieving analgesia in paediatric.These techniques are typically performed under general anaesthesia and are often performed utilizing ultrasound guidance. Head and neck, transversus abdominis plane (TAP), rectus sheath, ilioinguinal/ iliohypogastric (IL/IH), and upper and lower extremity blocks are commonly performed.
Managing pain in children is a complex area that requires an understanding of the unique challenges offered by this young population. Regional anesthesia is emerging as an adjunct to pain management in children, particularly in the perioperative arena.
Over the past 20 years, pediatric regional anesthesia has become an important part of patient care. Neuraxial and peripheral nerve blocks play a role in both postoperative pain
Summary
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management, treatment of acute pain such as after long bone fractures, in acute pancreatitis.
The diagnosis of chronic pain in children and adolescents has often been overshadowed by the potential for malingering and school phobia.Nevertheless, with greater stride in the field of pediatric acute pain, there is greater emphasis on the diagnosis and management of pain due to the potential for significant bio-behavioral changes with untreated pain.