Regional Anesthesia

Polaner, David M.; Suresh, Santhanam; Coté, Charles J.

doi:10.1016/b978-141603134-5.50046-9

Cited by 18 publications

(33 citation statements)

References 290 publications

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“…Complications could occur in the event of an intravascular injection . In the majority of cases in this study, the greater occipital nerve was found medial to the occipital artery, as described in the literature . However, in view of anatomic variation and the proximity of the occipital artery to the greater occipital nerve, careful aspiration is advised prior to injection of a local anesthetic.…”

Section: Discussionmentioning

confidence: 59%

Anatomy of the greater occipital nerve block in infants

Prigge

Schoor

Bösenberg

2019

Pediatric Anesthesia

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Background Pain relief for posterior fossa craniotomies as well as occipital neuralgia, are indications for the use of the greater occipital nerve block in children. The greater occipital nerve originates from the C2 spinal nerve and is accompanied by the occipital artery as it supplies the posterior scalp. Aims The aim of this study was to develop a unique, yet simple technique for blocking the greater occipital nerve in children through the evaluation of the anatomy of this nerve and the accompanying occipital artery in the occipital region. Methods The greater occipital nerve and occipital artery were dissected and exposed in six formalin‐fixed cadavers (five infants [average age of 51.4 days] and one 2‐year‐old) from the Department of Anatomy, University of Pretoria. Measurements between the nerve and selected bony landmarks were obtained. The relationship between the greater occipital nerve and the occipital artery at the trapezius muscle hiatus was also evaluated. Results The greater occipital nerve is on average 22.6 ± 5.6 mm from the external occipital protuberance in infants. The average width of the medial three fingers measured at the proximal interphalangeal joint, for each respective cadaver is 20.4 ± 4.0 mm, with a strong correlation coefficient of 0.97 between the aforementioned distances. In 83.3% of the specimens, the occipital artery lies lateral to the greater occipital nerve at the trapezius muscle hiatus. Conclusion In infants, the greater occipital nerve can be blocked approximately 23 mm from the external occipital protuberance, medial to the occipital artery. This distance is equal to the width of the medial three fingers at the proximal interphalangeal joint of the patient.

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Section: Discussionmentioning

confidence: 59%

Anatomy of the greater occipital nerve block in infants

Prigge

Schoor

Bösenberg

2019

Pediatric Anesthesia

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“…Anaesthesia was maintained with 60% nitrous oxide in oxygen and an inspired isoflurane concentration of 1-2%. Bilateral intra-oral, infra-orbital nerve block was performed using the technique as previously described [2][3][4].The patients were placed supine with the head in the median position and well supported. The infra-orbital foramen was externally located and a finger was placed over it; this acts as a guide and prevents the needle from penetrating into the infra-orbital foramen.…”

Section: Methodsmentioning

confidence: 99%

Bilateral intra‐oral, infra‐orbital nerve block for postoperative analgesia following cleft lip repair in paediatric patients: comparison of bupivacaine vs bupivacaine–pethidine combination

et al. 2007

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This prospective, randomised, double blind study compared the efficacy of pethidine as an adjuvant to bupivacaine with the efficacy of bupivacaine alone for infra-orbital nerve block in alleviating postoperative pain in children undergoing cleft lip repair. Forty paediatric patients aged between 5 and 60 months undergoing cleft lip repair were randomly allocated to two groups of 20. After tracheal intubation, group B received bilateral intra-oral, infra-orbital nerve block with 1 ml of 0.25% bupivacaine on each side and group P received 1 ml of 0.25% bupivacaine along with 0.25 mg.kg(-1) body weight pethidine. Sedation after recovery from anaesthesia was assessed using the University of Michigan Sedation Scale (UMSS) and pain was assessed postoperatively up to 36 h using the FLACC scale (Face, Legs, Activity, Cry, Consolability). The median (IQR) duration of analgesia from the time of administration of block in group B was 18 h (14.2-20) compared to 29.1 h (24-36) in group P (p = 0.001). Addition of pethidine as an adjunct to local anaesthetic significantly prolonged the duration of postoperative analgesia without any adverse effects.

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“…Several different surface landmark-guided techniques have been described, 21,[143][144][145][146][147] all of which are based on needle insertion at a prespecified distance medial and inferior to the ASIS, with an end point of either 1 or 2 tactile fascial pops. Unfortunately, the course and location of the II and IH nerves with regard to the ASIS vary significantly with age and between individuals.…”

Section: Landmark-guided Techniquementioning

confidence: 99%

Essentials of Our Current Understanding

Chin

McDonnell

Carvalho

et al. 2017

Regional Anesthesia and Pain Medicine

349

208

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Abdominal wall blocks rely on the spread of local anesthetic within musculofascial planes to anesthetize multiple small nerves or plexuses, rather than targeting specific nerve structures. Ultrasonography is primarily responsible for the widespread adoption of techniques including transversus abdominis plane and rectus sheath blocks, as well as the introduction of novel techniques such as quadratus lumborum and transversalis fascia blocks. These blocks are technically straightforward and relatively safe and reduce pain and opioid requirements in many clinical settings. The data supporting these outcomes, however, can be inconsistent because of heterogeneity of study design. The extent of sensory blockade is also somewhat variable, because it depends on the achieved spread of local anesthetic and the anatomical course of the nerves being targeted. The blocks mainly provide somatic analgesia and are best used as part of a multimodal analgesic regimen. This review summarizes the anatomical, sonographic, and technical aspects of the abdominal wall blocks in current use, examining the current evidence for the efficacy and safety of each.

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Regional Anesthesia

Cited by 18 publications

References 290 publications

Anatomy of the greater occipital nerve block in infants

Anatomy of the greater occipital nerve block in infants

Bilateral intra‐oral, infra‐orbital nerve block for postoperative analgesia following cleft lip repair in paediatric patients: comparison of bupivacaine vs bupivacaine–pethidine combination

Essentials of Our Current Understanding

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