Ultrasonographic guidance in pediatric regional anesthesia. Part 2: techniques (original) (raw)
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Ultrasound Imaging for Regional Anesthesia in Infants, Children, and Adolescents
Anesthesiology, 2010
Complementary to a previous publication related to pediatric extremity and trunk blockade, the authors present a comprehensive narrative review of the literature pertaining to techniques described and outcomes evaluated for ultrasound imaging in pediatric neuraxial anesthesia. The sonoanatomy related to each block is also described and illustrated to serve as a foundation for better understanding the block techniques described. For neuraxial blockade, ultrasound may fairly reliably predict the depth to loss of resistance and can enable a dynamic view of the needle and catheter after entry into the spinal canal. Particularly, in young infants, direct visualization of the needle and catheter tip may be possible, whereas in older children surrogate markers including the displacement of dura mater by the injection of fluid may be necessary for confirming needle and catheter placement. More outcome-based, prospective, randomized, controlled trials are required to prove the benefits of ul...
Ultrasound-guided Central Blocks in Infants, Children, and Adolescents
2011
R egional anesthesia is part of the curriculum for anesthesia training programs. Although the use of regional anesthesia in children has been limited, the field holds clear promise. The introduction of ultrasound (US) guidance, along with numerous focused workshops at major specialty meetings, have altered the outlook and increased participation and use of regional anesthesia in pediatric practice. This article will review the use of US-guided central neuraxial blocks as they apply to practice in infants, children, and adolescents. In particular, it will focus on 3 US-guided regional techniques-the caudal block, epidural analgesia, and the paravertebral block (PVB)-that are gaining popularity in this patient population.
Ultrasound-guided regional anaesthesia and paediatric surgery
Current Anaesthesia & Critical Care, 2009
s u m m a r y Regional anaesthesia is an important part of paediatric anaesthesia and plays a key role in peri-operative multimodal analgesic regimens. In recent years, the popularity of ultrasound-guided nerve blocks has significantly increased out of the recognition of its higher efficacy and safety. Its importance is further enhanced in paediatrics and especially in neonates as there are restrictions in the volume and maximum dosage of local anaesthetic that can be used. Ultrasound has allowed the usage of significantly smaller doses and concentrations by direct deposition of the drug around the nerve. It also allows the dynamic visualisation of the advancement of the block needle, adjacent anatomical structures and allows dynamic vision of local anaesthetic spread.
Is ultrasound essential for regional anesthesia in children?
Techniques in Regional Anesthesia and Pain Management, 2012
According to systematic reviews performed on adults, ultrasound provides moderate advantages in latency time reduction and block quality. Whether it really reduces the number of complications at the expense of less vascular puncturing, less diaphragm paralysis, and less pleural puncturing, together with lower doses of local anesthetic used, is a controversial question. Neither is there evidence that ultrasound achieves a higher rate of success than traditional techniques. Pediatric patients have special characteristics that differentiate them from adult patients, so the existing studies and their results should not be extrapolated. Ultrasound has a series of advantages: real-time visualization of our target or infiltration of anatomical plane; a view of the needle performing the puncture; and continuous monitoring of spreading of the local anesthetic. Few techniques satisfy so many requirements for adoption by the medical practice, but trials proving that this is an essential technique for pediatric regional anesthesia are scarce. However, ultrasound has shown to be at least as efficient and as safe as traditional techniques and should therefore be routinely used in pediatric regional anesthesia.
Role of Ultrasound in Pediatric Anesthesia
Journal of Anesthesia and Perioperative Medicine, 2018
Aim of review: The use of ultrasound for diagnosis and intervention has become a mainstay in pediatric anesthesia. It is safe to provide nerve blocks, caudal, epidural and spinal blocks under general anesthesia in children. Ultrasound use enhances the safety of these procedures. There is a wide range of applications for ultrasound. This review aims at addressing the most common applications for ultrasound in pediatric anesthesia. Methods: Systematic literature search and author expertise are incorporated in this review. Recent findings: Ultrasound is routinely used by pediatric anesthesiologists for diagnosis, regional anesthesia, and vascular access. Focused cardiac US (FoCUS) and Point of care US (PoCUS) is gaining popularity due to the ease of access to an ultrasound in the peri-operative setting. Summary: Ultrasound in pediatric anesthesia increases safety and has become the standard of care for central vascular access and regional anesthesia under general anesthesia. All practitioners who provide pediatric anesthesia care should become familiar with both the diagnostic and therapeutic uses for ultrasound in children.
Pediatric Regional Anesthesia: A Review and Update
Current Anesthesiology Reports, 2017
Purpose of Review This review summarizes the main regional anesthesia techniques currently in use for pediatric patients and identifies the recent evidence for their safety and efficacy. Recent Findings The Pediatric Regional Anesthesia Network (PRAN) database with over 115,000 documented nerve blocks has addressed the question of safety for a variety of techniques. PRAN has demonstrated that caudal epidural blocks, interscalene brachial plexus blocks, transversus abdominus plane (TAP) blocks, and neonatal caudal catheters have been routinely performed under general anesthesia in the pediatric population without significant report of adverse events. Randomized controlled trials have shown that paravertebral catheters perform favorably compared to thoracic epidurals for thoracic procedures without the side effects of hypotension and urinary retention. Summary Pediatric nerve blocks continue to grow as the new standard for pediatric pain control. Concerns about performance of blocks under general anesthesia have largely been eliminated now that ultrasound guided blocks are routine. New horizons include truncal blocks including TAP, quadratus lumborum, paravertebral blocks, and catheters as well as increasing performance of extremity blocks, even in the setting of trauma.
Peripheral regional anesthesia in infants and children: an update
Peripheral regional anesthesia in children has had a recent surge in popularity among pediatric anesthesia providers. The increased prevalence is at least in part explained by the proliferation of ultrasonography in the perioperative arena. Ultrasound-guided peripheral nerve block techniques have given pediatric anesthesiologists confidence to approach the diminutive structures that are in close approximation to sensitive areas. The three major categories of pediatric peripheral nerve blocks are upper extremity, truncal, and lower extremity. The indications, ultrasound anatomy, ultrasound-guided technique, and potential complications of the nerve blocks in each category are reviewed.
British Journal of Anaesthesia, 2006
Background. The purpose of this study was an anatomical and clinical evaluation of ultrasonography-guided rectus sheath blocks in children. Method. A total of 30 children were included in the sono-anatomical part of the study. The depth of the anterior and posterior rectus sheath was evaluated with a portable SonSite 180 plus ultrasound machine and a 5-10 MHz linear probe. In total, 20 consecutive children undergoing umbilical hernia repair were included in the clinical part of this study. After induction of general anaesthesia children received a rectus sheath block under real-time ultrasonographic guidance by placing 0.1 ml kg À1 bilaterally in the space between the posterior aspect of the sheath and the rectus abdominis muscle. Results. Ultrasonographic visualization of the posterior rectus sheath was possible in all children. The correlation between the depth of the posterior rectus sheath and weight (adjusted r 2 =0.175), height (adjusted r 2 =0.314) and body surface area (adjusted r 2 =0.241) was poor. The ultrasoundguided rectus sheath blockade provided sufficient analgesia in all children with no need for additional analgesia in the perioperative period. Conclusion. The bilateral placement of levobupivacaine 0.25% 0.1 ml kg À1 in the space between the posterior aspect of the rectus sheath and the rectus abdominis muscle under real-time ultrasonographic guidance provides sufficient analgesia for umbilical hernia repair. The unpredictable depth of the posterior rectus sheath in children is a good argument for the use of ultrasonography in this regional anaesthetic technique in children.
Pediatric regional anesthesia: The appropriate materials
Techniques in Regional Anesthesia and Pain Management, 1999
The importance of selecting appropriate devices (eg, needles, catheters, and nerve stimulators) to perform a regional block in children has long been underestimated. This attitude is no longer acceptable because it is now established that half the complications currently reported after performance of a regional block in children are related to the use of the wrong device. Specifically, devices are now available for virtually all types of regional block procedures and techniques of nerve/space location that do not depend on the cooperation of the patient have been fully evaluated in children and should be routinely used in pediatric anesthesia.
Regional anesthesia in pediatrics – Non-systematic literature review
Colombian Journal of Anesthesiology, 2015
Introduction: The use of pediatric regional anesthesia has grown to become the standard of care, because of its effective pain control, improved safety profile of the local anesthetic agents, in addition to the introduction of ultrasound. Objective: To perform a non-systematic review of pediatric regional anesthesia. Methods and materials: A search was conducted on the available scientific evidence in databases (Pubmed/Medline, ScienceDirect, OVID, SciELO), for a non-systematic review. Conclusions: The use of pediatric regional anesthesia has increased due to its notable effect on pain management and furthermore as a result of the incremented use of ultrasound technology.