Ultrasound-guided upper and lower extremity nerve blocks in children

Abstract

Discuss the role of ultrasound-guided regional anaesthesia in paediatric practice. Summarise the acute postoperative benefits of regional anaesthesia and its role in chronic pain management. Identify the appropriate surgical indications for peripheral nerve blocks in children and their potential complications. Demonstrate the key anatomical aspects and technical steps for performing peripheral nerve blocks in children safely. Paediatric regional anaesthesia (RA) has become an integral part of the current paediatric anaesthetic care. Although Dalens had established the first paediatric RA teaching programme in France by the early 1980s, its scope in the paediatric anaesthetic practice has significantly expanded as a result of the recent enhancement in the ultrasound (US) image quality. 1 Despite the paucity of randomised controlled studies in paediatric compared with adults, evidence of the benefits of RA in children has started to emerge. 2 In infants, RA improves haemodynamic stability, reduces the incidence of postoperative respiratory complications, decreases catecholamine production and the metabolic stress response to surgery and promotes a fast return of gut function and feeding. 3 Studies in older children have also shown that RA reduces postoperative opioid consumption. 4e7 Updates from the latest North America Pediatric Regional Anesthesia Network (PRAN) registry of more than 100,000 nerve blocks showed that RA in children has an acceptable level of safety comparable with adult practice, with US technology progressively replacing nerve stimulator techniques and with the majority of nerve blocks being performed under general anaesthesia. 8 Neuraxial blocks are gradually abandoned in favour of single-shot or continuous peripheral nerve blocks (PNBs). This article briefly discusses the consent process for RA in children, and illustrates the clinical indications (Table 1) and technical aspects of the most common and less traditional single-injection US-guided peripheral limb nerve blocks and the indications for and management of continuous peripheral nerve catheters.

[Retracted] Application of Ultrasound‐Guided Upper Trunk Brachial Plexus Block in Observation of Lower Shoulder Surgery

“…Although the effect of patient-controlled intravenous analgesia is obvious, patients are prone to drug dependence, nausea and vomiting, dizziness, respiratory depression, or skin pruritus and other adverse reactions, causing pain to some patients. Therefore, multiple nerve blocks are performed before shoulder arthroscopic surgery to relieve postoperative pain [ 28 ].…”

New blocks on the kids: core basic nerve blocks in paediatric anaesthesia

“…Shoulder surgery is uncommon in children and so the interscalene approach to the brachial plexus is rarely performed, whereas axillary, supraclavicular and infraclavicular approaches are used more frequently [24].…”

Comparison Between Ultrasound-guided Caudal Analgesia versus Peripheral Nerve Blocks for Lower Limb Surgeries in Pediatrics: A Randomized Controlled Prospective Study

“…4 The scope of RA in the pediatric anesthetic practice has been much improved in providing peripheral nerves and neuraxial blocks because of the advancement in the US and the image quality making the procedure easier safe with less dose of local anesthetics and fewer complications. 5 The aim of this study was to compare the analgesic efficacy of two different regional analgesias: the ultrasoundguided caudal analgesia versus the peripheral nerve blocks for lower limb surgeries in pediatrics. The primary outcome of this study was to assess the duration of postoperative analgesia in addition to the total postoperative doses and frequency of opiates and parents satisfaction as secondary outcomes.…”

“…Because of the difficulties and inadequacies of the CA and lumbar plexus block studies have been carried out on the use of US-guided peripheral nerve blocks in pediatrics. 5,14 DeLong et al found that US-guided fascia iliaca compartment block in pediatrics' hip and knee surgeries provided comparable analgesia to lumbar plexus block with a more superficial and easier technique and with fewer complications. 15 Another two studies compared US-guided femoral nerve block versus systemic analgesics; Marinković et al performed femoral nerve block in pediatric patients who underwent knee surgery.…”