Pediatric regional anesthesia is in the verge of a new era due to both widespread use of ultrasound and new defined fascial plane blocks. But we should still discuss the controversial issues like genetics and obesity, as there are some unclear issues according to limited data.
In parallel with the changes in modern lifestyles, nutrition habits, and due to decreased physical activity obesity rates throughout the world continue to increase day by day. Change in both physiology and anatomy can lead to technical difficulties for performing regional techniques along with adjusting the drug doses.
Although it might not be difficult to identify a landmark such as bone and vessels in obese pediatric patients, it would be challenging to visualize muscles and fascial planes. Even though local anesthetic toxicity rates are low in pediatric patients,1 it is difficult to detect while these patients are under general anesthesia (GA).2 Due to the possibility of a changed local anesthetic distribution clinicians should be aware of its manifestations under GA.
When it comes to genetic disorders, it is even more difficult to talk clearly due to lack of data. There is only limited number of case reports and diversity of genetic disorders make it difficult to generalize recommendations. While the main concern must be the patient safety, consideration of regional technique should also be done according to risk versus benefit ratio, clinical experience and conditions of the practitioner.
Walker BJ, Long JB, Sathyamoorthy M, et al. Pediatric Regional Anesthesia Network Investigators. Complications in pediatric regional anesthesia: an analysis of more than 100,000 blocks from the pediatric regional anesthesia network. Anesthesiology 2018;129:721–722.
Lönnqvist, P-A, Ecoffey, C, Bosenberg, A, Suresh, S, Ivani, G. The European society of regional anesthesia and pain therapy and the American society of regional anesthesia and pain medicine joint committee practice advisory on controversial topics in pediatric regional anesthesia I and II: what do they tell us?Curr Opin Anaesthesiol 2017;30:613–620.
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