Ultrasonography-guided rectus sheath block in paediatric anaesthesia--a new approach to an old technique (original) (raw)
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Ultrasonographic guidance in pediatric regional anesthesia. Part 2: techniques
Pediatric Anesthesia, 2006
The benefits of regional anesthesia are well documented. The downsides of such techniques have been a significant failure rate and a potential for serious complications. Nearly, all regional blocks were first described as essentially 'blind' techniques. The development of high-resolution portable ultrasound (US) has made the use of US for regional anesthesia possible. Improved understanding of sonographic anatomy should lessen both the failure rate and the possibility of incurring serious complications. Natural caution has dictated that only a selection of blocks used in adults has been commonly used in pediatric practice, but with the aid of US, the repertoire of blocks for infants and children may be widened. The second part of this review will concentrate on the practice of both peripheral and central blocks.
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...
Cumhuriyet Medical Journal, 2018
The aim of this study is to investigate the contribution of transversus abdominis plane (TAP) block supported by intravenous ketamine sedation in children on intraoperative anesthesia and analgesia. Method: A total of 60 patients aged between 2 and 6 years, were included in the study. The patients were divided in three groups;the TAP block and ketamine group; the TAP block by inserting the laryngeal mask(LMA) and sevoflurane grup; and the LMA and sevoflurane group. Peroperative heart rates(HR), mean arterial pressures(MAP), amount of sevoflurane used, postoperative pain scores, number of children needing rescue analgesia, time required for the first analgesia were recorded. Results: Of the patients average age was 4 ± 1.1. There was no difference between the two block groups, in terms of HR and MAP; HR were higher and MAP were lower in the only sevoflurane group.In the group supported by a TAP block, the amount of sevoflurane used decreased(p<005). In the postoperative period, the HR, MAP and pain scores were higher in the only sevoflurane group(p <0,05). Rescue analgesia was applied to less number of patients in the groups with added block. There were longer analgesia durations in the block-supported groups(p<0.05). Conclusions: In this study, it was determined that TAP block added to general anesthesia or sedation in pediatric lower abdominal surgery reduced the need for intraoperative anesthesia, provided a more stable intraoperative hemodynamics and analgesia, and provided less pain scores, longer analgesia duration and less analgesia need in the postoperative period. Keywords: Children;ultrasound-guided transversus abdominis plane block; intraoperative anesthesia ÖZET Amaç: Bu çalışmanın amacı,çocuklarda intravenöz ketamin sedasyonuyla desteklenen transversus abdominis plane(TAP) bloğun intraoperatif anesteziye ve analjeziye katkısını araştırmaktır. Yöntem: 2-6 yaş arası toplam 60 hasta çalışmaya dahil edilmiştir. Hastalar 3 gruba ayrıldı; TAP blok ve ketamin grubu; larıngeal maske takılarak(LMA) TAP blok yapılan ve sevofluran grubu; LMA ve sevofluran grubu. Peroperatif kalp hızları(KH), ortalama arter basınçları(OAB), kullanılan sevofluran miktarı, postoperatif ağrı skorları, kurtarma analjezisine ihtiyaç olan çocuk sayısı, ilk analjeziye ihtiyaç duyulan zaman kaydedildi. Bulgular: Hastaların yaş ortalaması 4±1,1 idi. İki blok grup arasında KH ve OAB açısından fark yoktu; sadece sevofluran grubunda KH daha yüksek ve OAB daha düşüktü. TAP bloğu tarafından desteklenen grupta, kullanılan sevofluran miktarı azalmıştı(p <005). Postoperatif dönemde sadece sevofluran grubunda KH, OAB ve ağrı skorları daha yüksek bulundu(p <0,05). Blok eklenen gruplarda daha az sayıda hastaya kurtarma analjezi uygulandı. Blok destekli gruplarda daha uzun analjezi süreleri vardı(p <0.05). Sonuç: Bu çalışma ile, pediatrik alt batın cerrahisinde, genel anestezi ya da sedasyona eklenen TAP bloğun, intraoperatif anestezi ihtiyacını azalttığı, daha stabil intraoperatif hemodinami ve analjezi sağladığı, postoperatif dönemde ise daha düşük ağrı skorları, daha uzun analjezi süresi ve daha az analjezi ihtiyacı sağladığı saptanmıştır. Anahtar sözcükler: çocuk; ultrason eşliğinde transversus abdominis plane(TAP) blok; intraoperatif anestezi ClinicalTrials.gov.
Journal of Pediatric Surgery, 2017
Background: Regional anesthesia is commonly used in children. Our hypothesis was that percutaneous ultrasound-guided (PERC) rectus sheath blocks would result in lower postoperative pain scores compared to intraoperative (IO) rectus sheath blocks following umbilical hernia repair. Methods: A single-institution randomized blinded trial was conducted in pediatric patients undergoing elective umbilical hernia repair. The primary outcome was mean postoperative Wong-Baker pain score. Secondary outcomes included narcotic requirements and length of postoperative stay. Results: Fifty-eight patients were included: 28 PERC and 30 IO. Operating room time was significantly longer in the PERC group (41 vs. 35 min, p b 0.01). Mean postoperative pain scores (PERC-2.6 vs. IO-3.3, p = 0.11), morphine equivalents intraoperatively (PERC-0 vs. IO-0.04 mg/kg, p = 0.29) and postoperatively (PERC-0.04 vs. IO-0.09 mg/kg, p = 0.17), time to first postoperative narcotic dose (PERC-30 vs. IO-22 min, p = 0.33, logrank test), and postoperative length of stay (PERC-76 vs. IO-80 min, p = 0.44) were similar. Conclusion: Following umbilical hernia repair in children, percutaneous ultrasound-guided and intraoperative rectus sheath blocks resulted in similar mean postoperative pain scores. There were no differences in secondary outcomes such as time to first narcotic, narcotic requirements, and length of stay. The additional resources required to complete a percutaneous ultrasound-guided rectus sheath block may not be warranted. Type of study: Randomized controlled trial. Level of evidence: Level I.
PRILOZI, 2017
Background: Ultrasound guided rectus sheath block can block the ventral rami of the 7th to 12th thoracolumbar nerves by injection of local anesthetic into the space between the rectus muscle and posterior rectus sheath. The aim of this randomized double-blind study was to evaluate the analgesic effect of the bilateral ultrasound guided rectus sheath block as supplement of general anesthesia on patents undergoing elective umbilical hernia repair. Methods: After the hospital ethics committee approval, 60 (ASA I–II) adult patients scheduled for umbilical hernia repair were included in this study. The group I (n=30) patents received only general anesthesia. In the group II (n = 30) patents after induction of general anesthesia received a bilateral ultrasound guided rectus sheath block with 40 ml of 0.25% bupivacaine. In this study we assessed demographic and clinical characteristics, pain score - VAS at rest at 2, 4, 6, 12 and 24 hours after operation and total analgesic consumption of ...
Clinical implications of the transversus abdominis plane block in pediatric anesthesia
Paediatric anaesthesia, 2012
Optimal perioperative analgesia for infants and children after major abdominal surgery poses a challenge when central neuraxial techniques are contraindicated. As a regional anesthesia technique, the transversus abdominis plane (TAP) block has been shown to reduce opioid consumption and improve pain scores compared to traditional perioperative pain strategies. Accordingly, TAP blocks may be considered as an alternative to central neuraxial analgesia to optimize perioperative pain control. Advancements in ultrasound technology have further improved the reliability and safety profile of this technique. Despite growing recognition of the diverse clinical scenarios where TAP blocks may be of benefit, its use among pediatric anesthesiologists remains limited. This article describes the history, anatomy, and a review of the current literature on TAP blocks with an emphasis on outcomes in pediatric patients.
IP innovative publication pvt ltd, 2020
Introduction: Ultrasound guided (US) rectus sheath block, blocks ventral rami of 7th to 12th thoracic nerves by injection of local anaesthetics (LA) into the space between the rectus muscle and posterior sheath. The aim of the study was to evaluate the analgesic efficacy of Bupivacaine, Levobupivacaine and Ropivacaine in ultrasound guided bilateral rectus sheath block in patients undergoing umbilical surgeries. Materials and Methods: Patients received bilateral US-guided injection of total 30 mL of levobupivacaine (GpL) 0.25 % (or 0.375% of Ropivacaine (GpR) or 0.25%of Bupivacaine (GpB) respectively, behind the rectus muscle to detach it from its sheath. Analgesic efficacy of LA was evaluated using duration of analgesia, pain score at extubation and 1-16 hrs postoperatively and mean VAS (visual analogue scale) score to assess the quality of analgesia. Results: There were statistically significant differences in VAS scores between the groups L, R and B at all postoperative time points - 1hr, 2 hr, and 3hr till 16hrs. (P < 0.00001). The mean duration of analgesia in three groups was 9.300.92 hrs in Gp L, 13.021.17 hrs in Gp R and 6.2 0.83hrs in Gp B respectively. This difference was statistically significant (p =< 0.0001). Conclusions: Single shot of different local Anaesthetics in Ultrasound guided bilateral rectus sheath block provides postoperative analgesia up till 16hrs in patients with BMI 25-40kg/m2 undergoing umbilical surgeries with excellent VAS scores with Ropivacaine.
Ultrasound-guided umbilical nerve block in children: a brief description of a new approach
Pediatric Anesthesia, 2007
The most popular peripheral nerve blocks used in umbilical hernia repair are rectus sheath block and paraumbilical block. However, multiple anatomic variations have been described and some complications may occur. Ultrasonographic guidance of peripheral nerve blocks has reduced the number of complications and improved the quality of blocks. This case series describes a new ultrasound-guided puncture technique of the 10th intercostal nerve in pediatric umbilical surgery. Ten children (age range: 2-5 years) scheduled for umbilical hernia repair were included. Following the induction of general anesthesia, the ultrasonographic anatomy of the umbilical region was studied with a 10-MHz linear probe. An ultrasound-guided peripheral block of the 10th intercostal nerve in the lateral edge of both rectus abdominis muscles (RMs) was performed (total of 20 punctures). Surgical conditions, intraoperative hemodynamic parameters, and postoperative analgesia by means of the modified CHEOPS scale were evaluated. Umbilical anatomy was clearly identified by ultrasound in all cases. The epigastric vessels were identified--above the umbilicus--within the depth of the muscular mass of the RM. The spread of local anesthetic was ultrasound-controlled in all cases. However, the intercostal nerve could not be visualized. All blocks were effective during the surgery. Postoperative analgesia was only required in two children in the second postoperative hour. There were no complications. Ultrasound guidance enables performance of an effective umbilical block in the lateral edge of RM. Further studies should be carried on to visualize the intercostal nerve and to compare this technique with the classical ones.
Journal of Anaesthesiology Clinical Pharmacology, 2015
Background and Aims: We conducted a prospective study to examine the local anesthetic (LA) spread and the effectiveness for surgical anesthesia of ultrasound (US)-guided rectus sheath block (RSB) in adult patients undergoing umbilical hernia repair. Material and Methods: Thirty patients received at T-10 level a bilateral US-guided injection of 20 mL levobupivacaine 0.375% + epinephrine 5 μg/mL behind the rectus muscle to detach it from its sheath. Anesthetic spread into the rectus sheath was evaluated ultrasonographically at T-9 and T-11 levels and scored from 0 to 4. The RSB was defined effective for surgical anesthesia if it was able to guarantee an anesthetic level sufficient for surgery without any mepivacaine supplementation. Results: Overall, the block was effective for surgical anesthesia in 53.3% of patients (95% confidence interval, ±17.8). In the remaining patients, anesthesia supplementation was needed at cutaneous incision, whereas manipulation of the muscle and fascial planes was painless. No patients required general anesthesia. LA spreads as advocated (to T-9 and to T-11 bilaterally = spread score 4) in 8/30 patients (26.6%); in these cases, the block was 75% effective for surgery. The anesthetic spread was most negatively influenced by increased body mass index. Postoperative analgesia was excellent in 97% of patients. Conclusion: Use of RSB as an anesthetic management of umbilical herniorrhaphy is recommended only with anesthetic supplementation at the incision site.