الفهرس 
Anatomical and physiological considerationsOnly 14 pages are availabe for public view
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Abstract
In pediatric anesthesia, good and long lasting analgesia is essential to achieve happy children and satisfied parents. To guarantee this, many pediatric anesthetists included a variety of regional anesthetic techniques in their daily clinical practice. The goal of regional anesthesia in the pediatric population must always be the provision of effective, safe analgesia with low rate of side effects and complication The abdominal wall is made of muscle layers with the nerve supply running in between. For a successful block, exact knowledge of each muscle layer and the exact position of the target nerve are essential. Especially in case of pediatric blocks, as the thickness of the abdominal wall is less than that in adults which puts the abdominal organs in increased danger of injury. The same implies to pelvic nerves, which run in close proximity to pelvic structures and vessels. The central nervous system of children is less developed than adults with many anatomical differences. This makes the performance of a neuroaxial block more difficult in pediatrics. Neurological pain pathways are the same in children and adults. Therefore, it is important to realize that a child can feel pain as much as an adult. After the use of cocaine as a local anesthetic, many artificial local anesthetics have been developed. Although they possess a similar mechanism of action, they vary largely in many ways, regarding the pharmacokinetics and pharmacodynamics of each one. These differences are of most importance in pediatric anesthesiology due to the delicate and immature physiological systems. Those anatomic, physiologic, and pharmacologic factors that are unique to children can affect the performance and safety of regional anesthetic techniques. Once these differences are understood, regional anesthesia can be safely and efficaciously used, either as the sole anesthetic or as a supplement to general anesthesia, to provide a smooth intraoperative course and pain-free awakening. The advancement of ultrasound guidance for performance of peripheral and central, neuraxial blockade makes block performance more safe and easy, and may increase the use of these blocks. Many nerve block techniques have been performed in children with major success. Each block targets a specific nerve or group of nerves. Some aim at anesthetizing peripheral nerves such as Iliohypogastric/Ilioinguinal nerve block, Genitofemoral nerve block, Rectus sheath block, Transversus abdominis plane block, Dorsal penile nerve block, Pudendal nerve block and Paravertebral block. Other techniques aim at anesthetizing central compartment as Subarachnoid block, Epidural block and Caudal block. Each of these blocks can be performed either blindly or under Nerve stimulator or Ultrasound guidance. As with any medical intervention, performance of a regional block may carry some risk to the patient in the form systemic toxicity from local anesthetic or local complication due to the block performance process In this era of evidence-based medicine, enthusiasts claim that further prospective studies with larger sample sizes are necessary to demonstrate that regional anesthesia has significant benefits and offers a better outcome than other forms of analgesia in children.