Fascial plane blocks in children: Mechanisms, indications, controversies, and practical guidance: A narrative review

Fascial plane blocks in children are defined as the administration of local anaesthetic into myofascial or aponeurotic planes to reach nerves traversing these planes. They have expanded rapidly from adult practice to paediatrics, with reported benefits across thoracic, abdominal, and lower-extremity surgery. Paediatric evidence now includes narrative reviews, randomised controlled trials, and meta-analyses; however, variability in nomenclature, dosing, and spread, and inconsistent comparators (caudal/neuraxial vs peripheral) continue to fuel controversy. This review synthesises current paediatric data on thoracic block like serratus anterior plane block, erector spinae plane block, abdominal-like rectus sheath block, transversus abdominal plane block, quadratus lumborum block, and lower-extremity (fascia iliaca, adductor canal) blocks. It highlights paediatric anatomical and physiological considerations and appraises safety (including local anaesthetic systemic toxicity) and catheter techniques. The review also maps limitations and research priorities.