Regional Analgesia at the Pediatric Emergency Department

Adequate pain management is a key component of pediatric emergency care. The use of regional analgesia, particularly ultrasound-guided regional blocks, has gained momentum in recent years as part of pain management, reducing the need for opioids and serving as a safe and effective alternative to procedural sedation.

For anesthesiologists, this is now a routine tool mainly performed in the operating room. In adult emergency medicine, this tool has also been integrated and is sometimes performed by emergency physicians.

In children, performing ultrasound-guided regional blocks presents additional challenges compared to adults. The primary challenge in an unsedated child is maintaining cooperation throughout the procedure. Other difficulties include limited maneuverability due to their smaller size, reduced allowable volume of local anesthetics (based on weight), and more. For these reasons, most ultrasound-guided regional blocks in children are performed in the operationg room after sedation or general anesthesia. There are only a few case reports describing the use of simple ultrasound-guided regional blocks performed by emergency physicians in pediatric ED settings.

Approximately two years ago, this technique was introduced into routine use in the pediatric emergency department at Hillel Yaffe Medical Center. Since then, nearly 300 different blocks have been performed.

Study Objective: To collect a registry database of complication rates associated with regional analgesia during routine pediatric emergency department care between 2023 and 2025.

Inclusion criteria

• Children who visited the pediatric emergency department between 2023-2025 and underwent a nerve block during their visit.

Exclusion criteria

• Children who visited the emergency department but had the nerve block performed outside the emargency department setting (e.g., inpatient wards or operationg room), or if the block was performed by a physician not affiliated with the pediatric emergency department.