Baby steps to mastery: building blocks for novices in pediatric regional anesthesia.
John G Hagen, Deepa Kattail, Natalie Barnett, Robert Scott Dingeman, Cassandra Hoffmann, Michele Nichols, Angela D Stengel, Sampaguita Tafoya, Claude Ecoffey, Giorgio Ivani, Tripali Kundu, Per-Arne Lönnqvist, Annabel Pearson, Robert Wilder, Debabrata Banik, Noreddine Bouarroudj, Cheryl S L Chooi, Nandini Dave, Palanichamy Gurumoorthi, Kathryn S Handlogten, Stefan Heschl, James Koziol, J Matthew Kynes, Gabriela Lopez, Amjad Maniar, Maryrose Osazuwa, Vrushali Ponde, Ban C H Tsui, Lloyd R Turbitt, Santhanam Suresh
Author Information
John G Hagen: Anesthesiology & Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA hagenj@mskcc.org. ORCID
Deepa Kattail: Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada. ORCID
Natalie Barnett: Department of Anesthesiology and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina, USA. ORCID
Robert Scott Dingeman: Anesthesiology, Children's National, Washington, District of Columbia, USA.
Cassandra Hoffmann: Anesthesiology, Akron Children's Hospital, Akron, Ohio, USA.
Michele Nichols: Department of Anesthesia and Pain Medicine, American Society of Regional, Pittsburgh, Pennsylvania, USA.
Angela D Stengel: Department of Anesthesia and Pain Medicine, American Society of Regional, Pittsburgh, Pennsylvania, USA.
Sampaguita Tafoya: Anesthesia, Shriners Hospitals for Children Northern California, Sacramento, California, USA. ORCID
Claude Ecoffey: University Rennes 1, Rennes, France.
Giorgio Ivani: Pediatric Anesthesiology and Intensive cARE, Azienda Ospedaliero Universitaria Citta della Salute e della Scienza di Torino, Torino, Italy. ORCID
Tripali Kundu: Anesthesiology, Medstar Georgetown University, Washington, District of Columbia, USA.
Per-Arne Lönnqvist: Physiology & Pharmacology, Karolinska Inst, Stockholm, Sweden. ORCID
Annabel Pearson: Anesthesiology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.
Robert Wilder: Anesthesiology, Mayo Clinic in Minnesota, Rochester, Minnesota, USA.
Debabrata Banik: Anesthesiology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
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.
