الفهرس 
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Abstract
Regional anesthesia is now well established in pedi¬atric anesthetic practice. The primary reason for its reintroduction into pediatric practice in the 1980s was for postoperative pain management. Since then its popularity has continued to gain momentum as practitioners realize the obvious benefits of regional anesthesia. Proving this benefit is not easy as there are too few controlled studies with large enough num¬bers to allow evidence-based decision making. Furthermore, proving subtle differences between different methods of analgesia is extremely difficult. Many factors must be considered. These include the age and condition of the patient, pain measurement in different age groups, equipment and facilities avail¬able, the skill of the anesthesiologist, and the use of different local anesthetic agents all of which hamper our ability to provide consensus on ’best practice’.
Almost all regional anesthetic techniques used in adult patients can be used in children. The widely held view, that local anesthetic spreads extensively and in all directions in very small children, making optimally exact puncture techniques unnecessary, is inaccurate. Ultrasound guidance is an excellent tool to optimize these nerve blocks. Ultrasound-guided nerve blocks require an adequate level of extra training. Workshops to convey the elementary hands-on skills are indispensable, but competent supervision must also be available in the early phase practical application.
The management of intra and postoperative pain in children requires a rational approach, aiming to maximize both patient’s comfort and safety. Although it is well established that children experience pain and remember it to the same extent as adults do, adequate strategies of pain management in pediatrics and training necessary for its successful implementation are still lacking in some institutions. While neuraxial block procedures have long been established in pediatric anesthesia, specific nerve blocks, remain narraw spreading despite their excellent benefit/risk ratio. Single shot nerve block procedures are appropriate for many indications of pediatric surgery, including patients undergoing ambulatory surgery. The future holds promise for the wider use of indwelling catheter techniques and their impact on postoperative analgesia and health care economics.
Postoperative analgesia is usually the primary justification for regional anesthesia in infants and children. Excellence in anesthesia and perioperative medicine demands the use of regional anesthesia and analgesia in any situation where pain and the neuroendocrine stress response to trauma makes significant demands upon organ systems. This may be defined by the type of surgery, but it also depends upon the overall condi¬tion of the patient. Failing organ systems would sway the decision to employ regional nerve blocks towards more minor procedures. The type of block and when to apply it requires maturity of judgement.
Major toxicity from local anesthetics is so rare that it is reasonable to conclude that it is probably unnecessary to replace bupivacaine with newer drugs for routine practice. However, these newer drugs may be indicated in neonates or children with impaired hepatic function specifically where prolonged infusions are planned, and when a large dose in milligrams of a local anesthetic drug is needed for the anesthetic technique.
At the end pediatric regional anesthesaia which is the best, is the least one used and to give it its rights it should be used more and more widely to gain more and more from its advantages.