Pediatric regional anesthesia - update.

PURPOSE OF REVIEW: New topics in pediatric regional anesthesia are discussed.

RECENT FINDINGS: Continuous peripheral nerve blocks, new local anesthetics and the performance of regional blocks with ultrasonography guidance are summarized.

SUMMARY: Prolonged analgesia with continuous peripheral nerve blocks in the treatment of pediatric postoperative limb pain, sometimes with patient-controlled regional analgesia, should be preferred instead of continuous epidural analgesia. Levobupivacaine and ropivacaine display the same pharmacokinetic profile as racemic bupivacaine with less cardiac toxicity. Conversely, continuous infusion of these new local anesthetics offers the safest therapeutic index, especially in infants. Many adjuvants have been used, but clonidine offers clear advantages. Ultrasonography guidance blocks will probably become the reference technique for local anesthetics injection and regional anesthesia catheter placement; new training in this field should be available.