The first significant cornerstone of regional anesthesia, which has led to its widespread use, is the clinical utilization of ultrasound in block applications. Moreover, many different fascial plane block techniques have been described in parallel with the progress in knowledge in sonoanatomy and the success of the previously defined methods. It could be said that the next big step, especially for ‘pediatric regional anesthesia’, is the implementation of fascial plane blocks in daily practice.
Caudal block has long been the most applied technique for the pediatric age group. However, as known, the limited indications of caudal blocks along with the refrained complication profile make clinicians hesitate. So the clinical practice was limited to some classic best-known techniques and some experienced practitioners. Unfortunately, it is a well-known fact that 80% of pediatric patients undergoing surgery experience postoperative pain due to inadequate analgesia, and this undertreatment could lead to the development of chronic pain.1 A multicentric study showed that chronic pain could be seen up to 6.6% after common surgeries in pediatrics.2 With the introduction of ‘Fascial Plane Blocks’ into the practice, the clinicians started to have many options for daily cases. The simplicity, safety, and ease of the learning curve of these techniques make them find their place in current practice. Fascial plane blocks provide new avenues for delivering opioid-sparing analgesia while minimizing invasiveness and risks associated with older techniques. They are safe and effective options for treating acute postoperative pain and for both the treatment and prevention of chronic pain in infants and children.
Transversus abdominis plane(TAP) block might be the first ‘game-changer’, but now the trend is going on with multiple novel fascial plane blocks covering various sensory distributions. However, the data about these blocks are limited, and the debate about their efficacy continues.
Boric K, Dosenovic S, Jelicic Kadic A, et al. Interventions for postoperative pain in children: An overview of systematic reviews. Pediatr Anesth 2017;27:893–904. https://doi.org/10.1111/pan.13203
Mossetti V, Boretsky K, Astuto M, et al. Persistent pain following common outpatient surgeries in children: A multicenter study in Italy. Pediatr Anesth 2018;28:231–236.
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