Nerve Blocks around the Knee in Children

Abstract

Analgesia below the knee can be achieved by blocking the tibial nerve and the common peroneal nerve in the popliteal fossa, and the saphenous nerve adjacent to the knee. The anatomy and technique of nerve block in the popliteal fossa is described, the nerve being located prior to blockade using a peripheral nerve stimulator. The block as described has been used in children for postoperative analgesia, as a diagnostic block, and as an adjunct to the physiotherapy management of severe equinus deformity after brain injury.

Continuous sciatic block for leg and foot surgery in 160 children

“…Surgery included various procedures for total correction of foot (147) for congenital talipes equinovarus (CTEV), meningomyelocoele, polio, muscular dystrophy. Tendon lengthening, transfers for flail foot, from polio, meningomyelocele, muscular dystrophy (8) and fibular hemimelia with tibial bowing for osteotomy (5).…”

“…The sciatic nerve as the predominant nerve supplying the leg and foot lends itself ideally for performance of a block. There are many reports of single shot sciatic block in adults (5)(6)(7)(8)(9)(10) by various approaches but few of the use of a catheter for continuous blocks (1)(2)(3)(11)(12)(13)(14) and even fewer in children (15,16). We have been using continuous sciatic block for leg and foot surgery since 1998.…”

Regional anesthesia for pain relief in children

“…A popliteal fossa block provides analgesia for distal lower extremity surgery, such as clubfoot repair, with the advantage of distal unilateral analgesia and ease of catheter insertion. The approach is similar to that of the adult [58]. Complications should be rare, though hematoma formation may occur if popliteal vessels are traversed.…”

Lower limb nerve blocks in children using unsheathed needles and a nerve stimulator

“…Initially the Dupaco nerve stimulator was the only nerve stimulator available at our institution. Prior to performing the peripheral nerve block the output was determined by grasping the two electrodes between the thumb and index finger [6]. The output was then adjusted to the point where a tingling sensation in the fingers was just detectable-usually at a point midway between the first and second mark on the output scale.…”

“…Most anaesthetists prefer to use insulated needles which deliver maximum current density at the tip of the needle [2] but are expensive for routine use. Unsheathed, noninsulated, short bevelled needles are relatively cheap and their successful use has been described in adults [I] and children [6]. However, the technique has received little attention in the literature, particularly with regard to children.…”