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Regional Anesthesia in Children

The practice of pediatric regional anesthesia is several milleniums old. An Egyptian low relief of Saqqarah, carved about 2500 BC, shows a scene of circumcision (Fig. 1) in which an object (perhaps the famous "Stone of Memphis") appears to be employed for inducing anesthesia of the penis before the operation. The later occidental civilizations turned away from these traditional analgesic practices until the end of the nineteenth and the beginning of the twentieth centuries (1-6). During a brief period, spinal, then supraclavicular and caudal blocks gained enthusiastic but transient acceptance. However, these techniques fell progressively into disuse and were almost lost by the end of the first half of the twentieth century. The reasons for such disinterest were numerous. Some pertained to the considerable improvements in general anesthesia, both technically, due to the widespread acceptance and use of tracheal intubation and mechanical ventilation, and pharmacologically, due to the availability of safer agents (especially halothane). In contrast, regional anesthetic agents and techniques remained almost unchanged, and little information was available on the pharmacology of local anesthetics in children. Compared to general anesthesia, regional anesthesia was time-consuming, less reliable and potentially hazardous (with risks of legal complications), variable in duration and not flexible (lightening or deepening the level of anesthesia is impossible). Pediatric regional anesthesia required special skills and specially designed re-usable