Is ultrasound essential for regional anesthesia in children?

According to systematic reviews performed on adults, ultrasound provides moderate advantages in latency time reduction and block quality. Whether it really reduces the number of complications at the expense of less vascular puncturing, less diaphragm paralysis, and less pleural puncturing, together with lower doses of local anesthetic used, is a controversial question. Neither is there evidence that ultrasound achieves a higher rate of success than traditional techniques. Pediatric patients have special characteristics that differentiate them from adult patients, so the existing studies and their results should not be extrapolated. Ultrasound has a series of advantages: real-time visualization of our target or infiltration of anatomical plane; a view of the needle performing the puncture; and continuous monitoring of spreading of the local anesthetic. Few techniques satisfy so many requirements for adoption by the medical practice, but trials proving that this is an essential technique for pediatric regional anesthesia are scarce. However, ultrasound has shown to be at least as efficient and as safe as traditional techniques and should therefore be routinely used in pediatric regional anesthesia.