Baby steps to mastery: building blocks for novices in pediatric regional anesthesia
Pediatric regional anesthesia offers significant benefits, yet its adoption faces barriers, including perceived overcomplexity. This study aimed to identify and establish a set of core, high-value, low-complexity nerve blocks to improve perioperative pain management in pediatric patients. A four-round modified Delphi consensus study was conducted with an international panel of pediatric and regional anesthesia experts. An initial long list of regional techniques was compiled by the Steering Committee and refined through iterative input. Panelists rated each technique on a 10-point Likert scale for importance. Consensus was defined as ≥75% of panelists assigning a mean importance score of ≥8. Techniques receiving 50%-74% agreement were categorized as having strong agreement and considered for inclusion. The final selection was confirmed through a virtual roundtable discussion. Thirty-three experts representing 12 pediatric and regional societies participated. Consensus was reached on six regional techniques, with strong agreement (*) on two additional techniques, identifying eight core pediatric regional anesthesia blocks: supraclavicular brachial plexus block, rectus sheath block, transverse abdominis plane block*, suprainguinal fascia iliaca block*, femoral nerve block, adductor canal block, popliteal sciatic nerve block, and landmark-based caudal block. This consensus-driven framework defines a core set of pediatric regional anesthesia techniques that balance clinical effectiveness, feasibility, and accessibility. These findings provide a practical entry point for practitioners looking to incorporate pediatric regional anesthesia into their practice, regardless of prior experience. Future efforts should focus on standardized training, implementation research, and policy initiatives to support widespread adoption and improve perioperative pain management in children globally.
Authors
- Natalie Barnett (ORCID: https://orcid.org/0000-0001-6589-922X)
- Michele Nichols
- Santhanam Suresh (ORCID: https://orcid.org/0000-0002-2568-5830)
- Annabel Pearson
- Amjad Maniar (ORCID: https://orcid.org/0000-0003-2415-4912)
- Deepa Kattail (ORCID: https://orcid.org/0000-0002-8388-4192)
- Ban C. H. Tsui (ORCID: https://orcid.org/0000-0002-6984-5998)
- Claude Ecoffey (ORCID: https://orcid.org/0000-0002-4458-6811)
- Gabriela López (ORCID: https://orcid.org/0000-0001-8622-8935)
- Stefan Heschl (ORCID: https://orcid.org/0000-0001-6123-8571)
- Cheryl Chooi (ORCID: https://orcid.org/0000-0001-5480-9890)
- Cassandra Hoffmann (ORCID: https://orcid.org/0000-0002-2802-4325)
- Noreddine Bouarroudj (ORCID: https://orcid.org/0000-0001-6058-8123)
- J. Matthew Kynes (ORCID: https://orcid.org/0000-0003-0487-6600)
- John G. Hagen (ORCID: https://orcid.org/0000-0001-7756-9367)
- Sampaguita Tafoya (ORCID: https://orcid.org/0000-0002-6672-6109)
- Maryrose Osazuwa (ORCID: https://orcid.org/0000-0001-8413-5911)
- Per‐Arne Lönnqvist (ORCID: https://orcid.org/0000-0002-8586-1429)
- Nandini Dave (ORCID: https://orcid.org/0000-0002-5808-5161)
- Lloyd Turbitt (ORCID: https://orcid.org/0000-0003-4354-3542)
- Angela D Stengel (ORCID: https://orcid.org/0000-0002-7701-924X)
- R. Scott Dingeman
- Giorgio Ivani (ORCID: https://orcid.org/0000-0001-6287-2398)
- Vrushali Ponde (ORCID: https://orcid.org/0000-0001-6300-7240)
- Debabrata Banik
- Kathryn S. Handlogten (ORCID: https://orcid.org/0000-0002-5456-3453)
- Palanichamy Gurumoorthi (ORCID: https://orcid.org/0000-0001-9340-1046)
- Robert T. Wilder
- Tripali Kundu
- James Koziol (ORCID: https://orcid.org/0009-0000-6793-3583)
Institutions
- University Frères Mentouri Constantine 1 (DZ)
- Rush University Medical Center (US)
- Royal Children's Hospital (AU)
- Mayo Clinic (US)
- Memorial Sloan Kettering Cancer Center (US)
- Children's National (US)
- University of Ulster (GB)
- Medical University of South Carolina (US)
- Georgetown University (US)
- Bangladesh Medical University (BD)
- Medical University of Graz (AT)
- Centro Hospitalario Pereira Rossell (UY)
- P. D. Hinduja Hospital and Medical Research Centre (IN)
- University Hospitals Bristol NHS Foundation Trust (GB)
- Hospital for Sick Children (CA)
- MedStar Georgetown University Hospital (US)
- American Pain Society (US)
- Flinders Medical Centre (AU)
- Karolinska Institutet (SE)
- Université Rennes 2 (FR)
- Azienda Ospedaliera Citta' della Salute e della Scienza di Torino (IT)
- Akron Children's Hospital (US)
- National Hospital Abuja (NG)
- Shriners Hospitals for Children - Northern California (US)
- Sparsh Hospital (IN)
- Kijabe Hospital (KE)
- Royal Victoria Hospital (GB)
- École Normale Supérieure de Constantine (DZ)
- Mayo Clinic in Florida (US)
- Ganga Hospital (IN)
- SRCC Children’s Hospital (IN)
- Stanford University (US)
Publication Details
- Journal
- Regional Anesthesia & Pain Medicine
- Published
- 2025-04-01
- DOI
- https://doi.org/10.1136/rapm-2025-106434
- Citations
- 2
- Primary Topic
- Anesthesia and Pain Management
- Type
- article
- Field-Weighted Citation Impact
- 4.01
Funders
- American Society of Regional Anesthesia and Pain Medicine