Hagen John G, Kattail Deepa, Barnett Natalie, Dingeman Robert Scott, Hoffmann Cassandra, Nichols Michele, Stengel Angela D, Tafoya Sampaguita, Ecoffey Claude, Ivani Giorgio, Kundu Tripali, Lönnqvist Per-Arne, Pearson Annabel, Wilder Robert, Banik Debabrata, Bouarroudj Noreddine, Chooi Cheryl S L, Dave Nandini, Gurumoorthi Palanichamy, Handlogten Kathryn S, Heschl Stefan, Koziol James, Kynes J Matthew, Lopez Gabriela, Maniar Amjad, Osazuwa Maryrose, Ponde Vrushali, Tsui Ban C H, Turbitt Lloyd R, Suresh Santhanam
Anesthesiology & Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.
Reg Anesth Pain Med. 2025 Apr 1. doi: 10.1136/rapm-2025-106434.
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.
小儿区域麻醉有显著益处，但其应用面临诸多障碍，包括被认为过于复杂。本研究旨在确定并建立一套核心的、高价值、低复杂性的神经阻滞方法，以改善小儿患者围手术期的疼痛管理。对国际小儿与区域麻醉专家小组进行了四轮改良德尔菲共识研究。指导委员会编制了一份初步的区域技术长名单，并通过反复输入进行完善。小组成员对每项技术的重要性按10分制李克特量表进行评分。共识定义为≥75%的小组成员给出的平均重要性得分≥8分。获得50%-74%认可的技术被归类为有强烈共识，并考虑纳入。最终选择通过虚拟圆桌讨论得以确认。来自12个小儿和区域学会的33位专家参与其中。就六种区域技术达成了共识，另外两种技术有强烈共识（），确定了八种核心小儿区域麻醉阻滞：锁骨上臂丛神经阻滞、腹直肌鞘阻滞、腹横肌平面阻滞、腹股沟上髂筋膜阻滞*、股神经阻滞、收肌管阻滞、腘部坐骨神经阻滞和基于体表标志的骶管阻滞。这个由共识驱动的框架定义了一组核心的小儿区域麻醉技术，这些技术在临床有效性、可行性和可及性之间取得了平衡。这些发现为希望将小儿区域麻醉纳入其临床实践的从业者提供了一个实用的切入点，无论其先前经验如何。未来的工作应集中在标准化培训、实施研究和政策倡议上，以支持全球范围内小儿区域麻醉的广泛应用，并改善小儿围手术期的疼痛管理。
