Introduction – Pediatric Regional Anesthesia
Over the past 30 years, pediatric regional anesthesia has come of age. There is now a large and rapidly growing body of information regarding the impact of development on pain responses, local anesthetic pharmacology, and the adaptation of a full range of regional anesthetic techniques for infants and children. There is also a quickly expanding literature on safety and efficacy from registries and clinical trials. Thirty years ago, in most pediatric centers worldwide, regional anesthesia was used for only a small fraction of surgeries. Today, it is an essential part of pediatric anesthetic and analgesic management throughout the world. For children in tertiary centers in highly developed countries, regional anesthesia is recognized as an essential component of multimodal analgesic regimens that seek to provide pain relief with movement; diminish opioid use, with a corresponding reduction in opioid side-effects; and facilitate early mobilization, early enteral feeding, and early hospital discharge. Some preliminary studies in infant humans and infant animals suggest that regional anesthesia may have an impact on preventing prolonged changes in central nervous system responses to surgical trauma. In lower resource settings, pediatric regional anesthesia is more often used as a primary anesthetic approach, based on considerations of cost, safety, and reduced need for postoperative intensive care. In the face of ongoing controversy over the impact of general anesthetics on the developing brain, regional anesthesia has a growing role for neonates, infants, and toddlers as an approach to limiting general anesthetic dosing and overall exposure.
Overview
Ban Tsui and Santhanam Suresh have been pioneers in this effort, and it is fitting that they are co-editing this wonderful textbook. Both editors have made fundamental innovations in the field over the past 20 years, and both continue to innovate and to mentor to a new generation of investigators and clinicians.
This book is superb in every way. As an atlas, it is first-rate. Anatomic drawings, diagrams, photos, and ultrasound images are combined in ways that masterfully guide the reader. The introductory sections outline the physics behind nerve stimulation and ultrasound in a way that is both sophisticated and highly practical for the clinician. The chapter entitled “Clinical and Practical Aspects of Ultrasound Use” codifies a set of clinical pearls in a clear and useful manner. The chapters that discuss pain assessment, pharmacology, and complications are practical and up-to-date. Part III covers the clinical anatomy of the various regions of the body with relevance to the conduct of regional anesthesia. Throughout these sections, the illustrations are outstanding, with just the right level of detail and the right points of emphasis. Parts IV, V, VI, VII, VIII, IX, and X build on these foundations to elucidate the “how-to” for the full range of regional anesthetic blocks. No other textbook, adult or pediatric, gives such clear guidance on how to perform a block, how to troubleshoot, how to avoid pitfalls, and how to analyze and solve clinical problems. Throughout these sections, there is a great balance between the science and the art of regional anesthesia. In every chapter, there is an authoritative reference list.
I am left with only one criticism, namely the title. This book is a magnificent atlas, but it is really much more than that: it is by far the definitive textbook on pediatric regional anesthesia.
Charles Berde, MD, PhD
Professor of Anesthesia (Pediatrics), Harvard Medical School,
Children’s Hospital Boston, Boston, MA, USA