2026-02-09
Should nerve blocks become the norm in children?
Anesthesia and Intensive Care
By Ana Espino | Published on February 9, 2026 | 3 min read
Managing acute pain in children remains a major challenge in anesthesia, particularly in the postoperative setting. Despite advances in anesthetic techniques, opioid-based strategies are still widely used, although they carry risks of side effects (nausea, respiratory depression, postoperative agitation) and long-term complications such as nociceptive sensitization and potential medication misuse.
Given these limitations, regional anesthesia techniques are emerging as an effective, targeted, and better-tolerated alternative, allowing nociceptive transmission to be blocked close to the surgical site. However, their systematic integration into pediatric practice remains limited due to logistical, technical, and cultural barriers, including fears of neurological complications and lack of training.
In this context, the aim of this study was to review recent data on regional anesthesia in children, assessing its efficacy, safety, main indications, and potential for broader and more structured use.
This review is based on a detailed analysis of recent scientific literature, supplemented by data from prospective registries such as the Pediatric Regional Anesthesia Network (PRAN), which includes tens of thousands of pediatric regional anesthesia procedures.
The most commonly used techniques include peripheral nerve blocks (femoral, ilioinguinal, sciatic, axillary) and neuraxial blocks (epidural, caudal, spinal anesthesia). The adoption of ultrasound guidance has revolutionized practice by improving precision, reducing technical failure rates, and minimizing complications.
Findings show that the rate of major neurological complications is extremely low (< 0.02%), even in infants and young children. Regional blocks are clearly effective in reducing postoperative pain, decreasing opioid use, and enhancing recovery, especially after orthopedic or abdominal surgery.
Moreover, blocks performed under general anesthesia—a common approach in pediatrics—do not appear to increase the risk of neurological complications, provided that appropriate monitoring is in place. Continuous catheter techniques are also expanding, particularly for managing prolonged pain following major surgeries.
Pediatric postoperative pain remains a complex issue that is often inadequately addressed by conventional strategies. The main challenge is to systematically implement techniques that are both effective and safe, without increasing the burden of anesthetic care. The goal of this review was to demonstrate that pediatric regional anesthesia represents a strong option, supported by robust safety data and well-documented clinical benefits.
However, several limitations remain and justify further research. Future investigations should include comparative evaluations of nerve blocks by type of surgery, standardization of techniques based on age and weight, and targeted training for pediatric teams in ultrasound guidance. It will also be essential to better integrate these techniques into multimodal care pathways, and to explore their long-term impact on neurological development, with the aim of establishing regional anesthesia as a central pillar in the management of pain in children.
About the author – Ana Espino
PhD in Immunology, specialized in Virology
As a scientific writer, Ana is passionate about bridging the gap between research and real-world impact. With expertise in immunology, virology, oncology, and clinical studies, she makes complex science clear and accessible. Her mission: to accelerate knowledge sharing and empower evidence-based decisions through impactful communication.
Managing acute pain in children remains a major challenge in anesthesia, particularly in the postoperative setting. Despite advances in anesthetic techniques, opioid-based strategies are still widely used, although they carry risks of side effects (nausea, respiratory depression, postoperative agitation) and long-term complications such as nociceptive sensitization and potential medication misuse.
Given these limitations, regional anesthesia techniques are emerging as an effective, targeted, and better-tolerated alternative, allowing nociceptive transmission to be blocked close to the surgical site. However, their systematic integration into pediatric practice remains limited due to logistical, technical, and cultural barriers, including fears of neurological complications and lack of training.
In this context, the aim of this study was to review recent data on regional anesthesia in children, assessing its efficacy, safety, main indications, and potential for broader and more structured use.
Do blocks really change the game?
This review is based on a detailed analysis of recent scientific literature, supplemented by data from prospective registries such as the Pediatric Regional Anesthesia Network (PRAN), which includes tens of thousands of pediatric regional anesthesia procedures.
The most commonly used techniques include peripheral nerve blocks (femoral, ilioinguinal, sciatic, axillary) and neuraxial blocks (epidural, caudal, spinal anesthesia). The adoption of ultrasound guidance has revolutionized practice by improving precision, reducing technical failure rates, and minimizing complications.
Findings show that the rate of major neurological complications is extremely low (< 0.02%), even in infants and young children. Regional blocks are clearly effective in reducing postoperative pain, decreasing opioid use, and enhancing recovery, especially after orthopedic or abdominal surgery.
Moreover, blocks performed under general anesthesia—a common approach in pediatrics—do not appear to increase the risk of neurological complications, provided that appropriate monitoring is in place. Continuous catheter techniques are also expanding, particularly for managing prolonged pain following major surgeries.
Relieving pain without raising the risk?
Pediatric postoperative pain remains a complex issue that is often inadequately addressed by conventional strategies. The main challenge is to systematically implement techniques that are both effective and safe, without increasing the burden of anesthetic care. The goal of this review was to demonstrate that pediatric regional anesthesia represents a strong option, supported by robust safety data and well-documented clinical benefits.
However, several limitations remain and justify further research. Future investigations should include comparative evaluations of nerve blocks by type of surgery, standardization of techniques based on age and weight, and targeted training for pediatric teams in ultrasound guidance. It will also be essential to better integrate these techniques into multimodal care pathways, and to explore their long-term impact on neurological development, with the aim of establishing regional anesthesia as a central pillar in the management of pain in children.
Read next: Postoperative delirium: does melatonin really work?
About the author – Ana Espino
PhD in Immunology, specialized in Virology
As a scientific writer, Ana is passionate about bridging the gap between research and real-world impact. With expertise in immunology, virology, oncology, and clinical studies, she makes complex science clear and accessible. Her mission: to accelerate knowledge sharing and empower evidence-based decisions through impactful communication.
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