Baby Blocks

Baby Blocks A Vanguard of Pediatric Perioperative
Ultrasound & Regional Anesthesia.

From regional nerve blocks, to vascular access, to POCUS, our experts offer detailed descriptions to help you integrate this knowledge into your current practice.

Zero. That is the number of randomized controlled trials that have ever validated a maximum safe dose of any local anest...
06/05/2026

Zero. That is the number of randomized controlled trials that have ever validated a maximum safe dose of any local anesthetic.

Rosenberg and colleagues traced every published max dose recommendation back to its origin. What they found: animal experiments, case reports, pharmacokinetic extrapolations, and pharmaceutical company decisions. Not a single recommendation scored above Grade C evidence. The numbers you memorized in training were never tested the way we test anything else in medicine.

We broke this down recently — go back and swipe through if you missed it.

Did you know this? Does your training program teach where these numbers actually come from?

Source: Rosenberg et al. 2004, Reg Anesth Pain Med. PMID 15635516.

Free LA dosing calculator: baby-blocks.com/technique-detail/calculator (link in bio)

24,409 blocks. 23 complications. All from central blocks. Zero from peripheral. One paper. 1996.Giaufre published the fi...
05/25/2026

24,409 blocks. 23 complications. All from central blocks. Zero from peripheral. One paper. 1996.

Giaufre published the first large prospective registry of pediatric regional anesthesia: 38 institutions across France, Belgium, and Italy, tracking every block for a full year. The finding everyone remembers is that peripheral nerve blocks had zero complications, while central blocks carried all the risk.

But read the paper, not the citation.

The “peripheral blocks” in 1993 were mostly pe**le blocks and tracheal sprays. Only 1,393 of the 9,396 were true extremity nerve blocks. There was no ultrasound. Central blocks were 61.5% of all regional anesthesia. The menu was caudals, epidurals, and a handful of axillary and femoral blocks. Fascial plane blocks didn’t exist. Voluntary reporting means underreporting is possible. And half the complications came from wrong equipment, preventable with gear that exists today.

Here’s what I think matters most about this paper, though.

The specific numbers are outdated. The blocks are unrecognizable. The methodology has been superseded by PRAN and more than 100,000 blocks with institutional-level tracking. But the directional signal, favor peripheral when the anatomy allows, confirmed where modern practice was already heading. By 2010, Ecoffey’s ADARPEF follow-up showed central blocks had dropped from 61.5% to 34%. Walker confirmed the safety profile at massive scale in 2018. The field listened. The field is still listening.

That’s what a classic does. It doesn’t need to be perfect. It needs to ask the right question.

If you can get to Montevideo in October, LASRA’s hands-on workshop is where this kind of evidence meets practice: real blocks, real guidance, deliberate repetition at the table. If you can’t make it, baby-blocks.com is free and built to help you take that first step on your own.

Giaufre E, Dalens B, Gombert A. Anesth Analg. 1996;83:904-912.
Ecoffey C, Lacroix F, Giaufre E, et al. Pediatr Anesth. 2010;20:1061-1069.
Walker BJ, Long JB, Sathyamoorthy M, et al. Anesthesiology. 2018;129(4)721-732.

Cleft lip repair is one of the most common congenital surgeries in the world. After most of them, the child received int...
05/21/2026

Cleft lip repair is one of the most common congenital surgeries in the world. After most of them, the child received intraoperative opioids.

Thirty years of evidence says it doesn’t have to be that way.

Morzycki’s 2022 systematic review pulled together 39 studies on infraorbital nerve block for cleft lip. The Cochrane review — Feriani 2016 — looked at 8 RCTs. The heterogeneity is real. I-squared hit 99% in Morzycki. Across 39 studies, the block consistently reduced pain. The size of the benefit varies — but the direction doesn’t.

Rajamani randomized 82 children to bilateral infraorbital block with bupivacaine or IV fentanyl. The block group: 83% adequate analgesia vs 37%. Faster wake-up. Earlier feeding. Lower pain scores. The caveat is obvious — single-shot fentanyl vs a block that lasts hours is not a fair fight. But it tells you something about where the floor sits when the block is in.

Limitations worth naming. The pooled numbers from Morzycki are not headline-ready at that heterogeneity. Hematoma in about 4% of cases. The suprazygomatic maxillary block is typically ultrasound-guided. For cleft lip, the infraorbital has 30 years of evidence on its own — no equipment, no learning curve.

Here’s what we keep coming back to, though. Infraorbital block is landmark-based. A 25-gauge needle. 60 seconds. No ultrasound. No nerve stimulator. No special equipment. In settings where the ultrasound machine is shared across four ORs or doesn’t exist, that is not a minor advantage. That is the whole argument.

The data won’t tell you exactly how many minutes of pain relief to expect. It will tell you the block works — and that anyone with a needle can do it.

Baby Blocks x LASRA Workshop — Montevideo, October 15. Hands-on, small group. Reduced pricing through July 31. 🔗 link in bio

Infraorbital block guidance and dozens of pediatric techniques at baby-blocks.com.

Morzycki et al., J Plast Reconstr Aesthet Surg 2022;75(11):4221-4232
Feriani et al. (Cochrane), 2016. PMID 27074283
Rajamani et al., Paediatr Anaesth 2007;17:133-139. PMID 17238884

Will I hurt a child?Every clinician asks this before their first pediatric block. It is the right question. And the answ...
05/21/2026

Will I hurt a child?

Every clinician asks this before their first pediatric block. It is the right question. And the answer lives in three decades of prospective data.

Zero permanent neurologic injuries. Across 100,000+ blocks in the PRAN registry (Walker 2018). Across 31,000 blocks in the ADARPEF follow-up (Ecoffey 2010). Across 24,000 blocks in the original ADARPEF survey (Giaufré 1996). Three registries. Two continents. The same signal.

The caudal — the block most clinicians learn first — has its own dedicated safety analysis: 18,650 blocks, no permanent injuries (Suresh 2015). And blocks placed under general anesthesia in children are not associated with increased complications (Taenzer 2014, >50,000 blocks). Two common fears. Both addressed by large prospective data.

The honest caveat: these numbers come from experienced teams at academic children’s hospitals. Voluntary reporting means underreporting is possible. “Zero permanent” does not mean zero complications — transient events are documented. And the safety data reflects the best version of this practice: trained teams, ultrasound, protocols, immediate LAST management.

That is the point. The safety comes from the training. Not from the technique alone.

LASRA Montevideo, October 15 — Baby Blocks Regional Workshop. The skills behind the safety record, taught hands-on by the people who built it.

Registration: congresoanestesiologia.uy/inscripcion-congreso-lasra/ (Link 🔗 in bio)
Spaces are limited.

baby-blocks.com/safety

Walker 2018, Anesthesiology | Polaner 2012, Anesth Analg | Suresh 2015, Anesth Analg | Ecoffey 2010, Paediatr Anaesth | Giaufré 1996, Anesth Analg | Taenzer 2014, Reg Anesth Pain Med

Four randomized trials. 286 children. The first real evidence on PENG block for pediatric hip surgery.Here is what it sh...
05/21/2026

Four randomized trials. 286 children. The first real evidence on PENG block for pediatric hip surgery.

Here is what it shows — and what it does not.

PENG outlasted supra-inguinal fascia iliaca on time to first rescue analgesia: 9.5 vs 2.6 hours (Gbre 2026, n=60). It outlasted caudal epidural: 10.7 vs 7.9 hours (Amin 2026, n=80). Both statistically significant. Both single-center.

But the comparators deserve a closer look. The FICB arm had an unusually short duration. The caudal was dosed at 0.5 mL/kg — roughly half of what most practitioners would use for hip-level coverage. No adjuvants in any arm of any trial.

Against erector spinae plane block, the picture is split. Reysner 2025 (n=90, under spinal anesthesia) found PENG and ESP equivalent on every outcome. Mostafa 2024 (n=56, under GA) found ESP superior — longer time to first rescue, less morphine. Same surgery, different drugs, different anesthetic backgrounds, different ESP levels. A matched-protocol trial would settle it.

The motor-sparing claim? All four studies reference it. None of the four used a validated motor scale. Gbre, Amin, Reysner, and Mostafa each acknowledge this limitation in their own text. In adults, quadriceps weakness has been reported in 25% or more of PENG recipients. The pediatric question is genuinely open.

All four trials are single-center — two from Egypt, one from Poland, one from Egypt again. Sample sizes range from 56 to 90. No multicenter data. No long-term follow-up.

The BabyBlocks Take: PENG is an effective block for pediatric hip surgery. It is not yet proven superior to other motor-sparing techniques. The first RCTs are encouraging. The honest next step is a controlled comparison with an optimized comparator.

Swipe through for the full breakdown.

Sources: Gbre 2026 (BMC Anesthesiology), Amin 2026 (British Journal of Pain), Reysner 2025 (J Pediatr Orthop), Mostafa 2024 (Indian J Anaesth).
Full evidence matrix at baby-blocks.com/peng



Do you use PENG blocks for your pediatric patients?

Last week we showed you WHY to scan the stomach before you cancel that case.This week: how.The BabyBlocks gastric POCUS ...
04/28/2026

Last week we showed you WHY to scan the stomach before you cancel that case.

This week: how.

The BabyBlocks gastric POCUS technique page walks through the entire scan, start to finish. Free. No paywall. Written by Dr. Andrea Gomez-Morad with contributions from Dr. Anahi Perlas.

The short version:

Probe: Linear for kids under 40 kg. Curvilinear above that.

Position: Right lateral decubitus, head up 30-45 degrees. Gravity pulls fluid to the antrum where you can see it. Supine alone misses too much.

Find the antrum: Sagittal plane in the epigastrium, just caudal to the xiphoid. Deep to the left lobe of the liver, anterior to the aorta and SMA. Fan side to side until you get it.

Read the image:
- Empty = “bull’s eye.” Five-layer wall, collapsed lumen. That thick muscularis propria ring is your friend.
- Clear fluid = hypoechoic pool in a distended antrum.
- Solids = heterogeneous echogenicity, hard to see the posterior wall. Unmistakable once you’ve seen it.

Grade it (Perlas system):
Grade 0: No fluid in supine or RLD. Empty. Proceed.
Grade 1: Fluid in RLD only. Small volume, likely baseline secretions. Clinical judgment.
Grade 2: Fluid in both positions. This is a full stomach. Full stop.

For kids, stick with the qualitative grade.

Free at baby-blocks.com.

04/23/2026

The kid says he ate 🍲.
Mom says he didn’t eat.
He ate. 🤦‍♀️
We’ve all been there—uncertain fasting history before elective surgery. Wait? Cancel? RSI?
Or scan.
Mecoli et al.: 106 kids with questionable fasting → gastric POCUS
• 62% empty/low volume → proceeded
• 29% high risk → managed appropriately
• ⏱️ Saved ~2.6 hours
• Aspiration: 0
One scan. ~30 seconds. Real answers at the bedside.
Now add GLP-1s → delayed gastric emptying is real.
POCUS lets you act on it in real time.
The question isn’t the data.
It’s whether your institution is doing it yet.
Check out our 🌟 NEW ⭐️ POCUS content on our website!

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