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.
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.
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About the author – Ana EspinoPhD 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.
