Upper extremity nerve blocks in pediatric patients

For the last 25 years, regional anesthesia has gained an established place in pediatric anesthesia. Indications of plexus and conduction nerve blocks have increased considerably and upper limb blocks are now routinely used. In some institutions, these blocks are used for the management of virtually all aspects of surgical and procedural pain, including outpatient surgery, whether the techniques are used in conscious patients or in combination with general anesthesia. Even though they are still underused in many locations, upper limb blocks have a brilliant future due to their many advantages in terms of efficacy, safety, and ease with which they can be performed with the help of a nerve stimulator. The recent availability of devices allowing both electrolocation of nerve trunks and catheter placement along nerve paths represents a major improvement since it overcomes the only limitation of conduction blockade, which is the limited duration of effects of local anesthetics even with the addition of adjuvants. With catheter techniques, long lasting pain relief can be easily managed and all the infusion regimens used for decades during epidural analgesia become now applicable peripherally, including repeat injections, continuous infusion, and patient-controlled analgesia with infusion pumps or elastomeric devices. © 2003 Elsevier Inc. All rights reserved.