Indications (con't)

Lumbar plexus blocks have limited indications in pediatric patients and may be considered when a femoral block is contraindicated (infection at the site of puncture) or unsuitable (when sensory supply has a sciatic nerve component as for hip surgery). They may also represent a valuable alternative to epidural anesthesia for unilateral operations on the hip and thigh the more so as they allow easy catheter placement for long-lasting pain relief.[31]

The saphenous nerve block is mainly used to complement a sciatic nerve block for procedures bellow the knee or on the foot. Due to the small doses and volumes of LA that are required, this block does not significantly increase the risks of systemic toxicity.

Other block procedures of lumbar plexus nerves are little used in children. A lateral cutaneous nerve block can be used for muscle biopsy [26] and surgery of the soft tissues in the lateral aspect of the thigh but most anesthesiologists would prefer using a fascia iliaca compartment block or a three-in-one block in this indication. Obturator nerve blocks have virtually no speci-fic anesthetic indications; they might be suitable to facilitate rehabilitation of children with a history of spasticity but the benefits are short-lasting and its safety profile is dubious. For that reason, most anesthesiologists would prefer performing a lumbar plexus block or an epidu-ral anesthesia with placement of a catheter for repeat, continuous or on-demand injections of LA.