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Pediatric orthopaedic surgical procedures require a thoughtful multimodal approach to perioperative pain management that maximizes both patient comfort and safety. Local infiltrative anesthesia (LIA) has been commonly used with a variety of formulations and application methods. However, local anesthesia provides limited anatomic coverage over a relatively short length of time. In comparison, regional anesthesia can provide increased anatomic coverage over a longer duration by applying anesthetic medication directly around a targeted peripheral nerve or nerves. Peripheral nerve blocks (PNB) have become commonly used in pediatric and adolescent sports medicine procedures, especially for anterior cruciate ligament reconstructions (ACLR), but there is wide variation in how PNBs are performed with limited evidence in support of their overall benefits in children relative to potential complications, such as prolonged sensory or motor nerve paralysis. Even less is known about their use and indications for a variety of non-sports pediatric orthopaedic procedures. This article provides a review of the uses and indications of both local and regional anesthesia in pediatric orthopaedics with a discussion of the available evidence in the literature on safety and efficacy.