Ultrasound-guided regional anaesthesia is rapidly growing in popularity. Initially, most evidence was for the benefits when used in adults, but there is now a multitude of well-documented benefits in children. The practice of regional anaesthesia in children differs somewhat from that of adults in that in the majority of cases it is used for analgesia and performed under general anaesthesia to allow placement, rather than alone for anaesthesia as in adults. The purpose of this paper is to review the basic aspects of ultrasound regional anaesthesia before going into detail regarding specific techniques. 1. Introduction Regional anaesthesia is an increasingly popular area within anaesthesia. In adult practice, it is used alone to provide anaesthesia, and in combination with general anaesthesia to provide analgesia. However, this differs in paediatric practice where it is almost exclusively performed in combination with general anaesthesia, as it would be neither safe nor possible to attempt in the awake child due to lack of cooperation and potentially painful muscle stimulation. The benefits of regional anaesthesia in children are well documented. These include attenuation of the stress response, reduced opioid requirement, and therefore reduction in associated side effects, improved postoperative analgesia, and earlier extubation. Traditional methods of nerve localization include landmark and neurostimulation techniques, but these have significant failure rates. Ultrasound is becoming an important adjunct in regional anaesthesia, allowing real-time imaging of nerves and their surrounding structures. This not only increases rates of achieving a successful block, by allowing visualisation of the injectate entering the correct plane, but can also reduce complication rates as surrounding structures can be avoided. In addition, the use of ultrasound allows a regional block to be performed in circumstances where nerve stimulation would not elicit muscle contractions, for example, following administration of muscle relaxant or after amputation [1]. Ultrasound-guided regional anaesthesia was first described in 1994 by Kapral et al. [2] and since then the supporting literature has continued to expand. Recommendation for the use of ultrasound in the insertion of central lines in the NICE guidelines of 2002 [3] has resulted in an increase in the availability of portable ultrasound machines in the theatre environment. A study in 2007 found that 86% of departments had access to ultrasound [4]. Using ultrasound (US) allows real-time imaging of the needle and the nerve
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