Pediatric regional anesthesia: A review of the relevance of surface anatomy and landmarks used for peripheral nerve blockades in infants and children.

In regional anesthesia, accurate knowledge of surface anatomy and landmarks are essential for successful nerve blockades with least possible complications. The long-established anatomical landmarks used for peripheral nerve blockades in adult patients have also gained a place in pediatric anesthesia. Despite the continuing benefits and need for more effective peripheral techniques in pediatrics, there is a paucity of data on pediatric landmarks, and hence the absence of more appropriate techniques for the different age groups of children. Recent advancement in imaging has shown that there is a greater awareness for the different surface projections at various stages of postnatal development, as compared with that of adults. Thus, if adult landmarks are not appropriately adapted for use in children, complication rates may rise due to injuries to anatomical structures. This review evaluated the existing evidence of the pediatric nerve block landmarks in the reported literature, in order to highlight the limitations in our current understanding of pediatric surface anatomy and landmarks. A literature search was done using five databases to obtain 141 references. Only a few of these studies provided detailed reports of the relations of relevant nerves to anatomical landmarks. A few clinical imaging studies have provided new anatomical landmarks in children with reference to their age-related growth and anatomy. Most landmarks need to be standardized in children of various ages, and furthermore, inconsistencies in the current descriptions of the surface landmarks need to be validated and standardized for use in pediatric clinical practice. Clin. Anat. 32:803-823, 2019. © 2019 Wiley Periodicals, Inc.