Regional Anesthesia

When we're on the adult anesthesia side, there's a dedicated regional anesthesia team to do nerve blocks for appropriate surgeries: knee replacements, elbow surgeries, rotator cuff repairs. But on pediatrics, we get the opportunity to do blocks since there is no separate attending and resident for regional techniques. The challenges are different. Most nerve blocks are done while the patient is awake so that we can evaluate the efficacy of the block and monitor for adverse events. As you can imagine, children don't usually tolerate a needle attached to a nerve stimulator going into their neck. Sedation, distraction (for one teenager, we played a hip hop music video on the OR TVs), preparation, and reassurance are necessary for a smooth block. So far, I've seen and done some upper extremity nerve blocks for elbow and wrist surgeries, and it's been pretty fun.

The most common block, however, is the caudal block, which is placed in infants and toddlers and gives good pain relief for many surgeries below the umbilicus. In the same manner as an epidural, except using a tiny 22g IV catheter, we palpate landmarks on the baby's low back and insert a shallow needle into the epidural space and inject local anesthetic and clonidine. The pain relief is pretty remarkable as patients wake up comfortable after many different general, urologic, and orthopedic surgeries.