Evidence-based medicine: Assessment of ultrasound imaging for regional anesthesia in infants, children, and adolescents

This review was performed to evaluate and discuss the quality and outcomes of studies assessing ultrasound imaging in pediatric regional anesthesia. Literature searches were conducted using MEDLINE and EMBASE, combining the search term "ultrasonography" with "regional anesthesia," "nerve block," "epidural anesthesia," and "spinal anesthesia," with the limit of 0 to 18 years. Additional literature was sought from departmental files and recent issues of several major anesthesiology journals. Meta-analyses/systematic reviews, randomized controlled trials, clinical studies without either randomization or control (eg, comparative studies), and case series (n > 10) were collected, reviewed, and graded for their quality (Jadad scores) and level of evidence (Grades of Recommendation). The search resulted in 211 total publications in pediatric literature, of which 12 were included in the evaluation of peripheral nerve blocks and 12 in the evaluation of neuraxial anesthesia. Although there is some evidence to support ultrasound for various outcomes in pediatric regional anesthesia, more randomized controlled studies with sufficient power are required to further support these findings and to evaluate the potential for ultrasound to reduce complications for regional anesthesia in children.