Abstract The performance of regional anesthetic techniques on anesthetized children is an accepted standard of care in the international pediatric anesthesia community. Despite recent editorials condemning its practice in adults, these combined techniques continue to grow in pediatric anesthesia. Prospective and retrospective studies have been published establishing their safety and efficacy. Complications have been recognized in these studies and in case reports. These complications are related to inadvertent intravascular injection of local anesthetics, epidural identification by loss of resistance with air, inadequate knowledge of pediatric anatomy, and inappropriate equipment selection, not because the child was under general anesthesia. These complication rates compare favorably with similar techniques performed on conscious adults. Continuous epidural techniques are widely employed with significant effort directed at achieving the appropriate dermatomal level so local anesthetic-opioid infusions can be provided postoperatively. Performing these techniques in patients under general anesthesia facilitates the application of regional anesthesia in children. Copyright © 2000 by W.B. Saunders Company