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Brachial plexus anaesthesia in children Temena

Ultrasound guidance for infraclavicular brachial plexus anaesthesia in children

Summary:

Ultrasonography may offer significant advantages in regional anaesthesia of the upper and lower limbs. It is not known if the same advantages demonstrated in adults also apply to children. We therefore performed a prospective, randomised study comparing ultrasound visualisation to conventional nerve stimulation for infraclavicular brachial plexus anasesthesia in children. Forty children scheduled for arm and forearm surgery underwent infraclavicular brachial plexus blocks with ropivacaine 0.5 ml.kg)1 guided by either nerve stimulation or ultrasound visualisation.

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This new virtual platform is characterized by:

  • Exclusively for physicians. Still limited to three specialties: anesthesia, emergency medicine, orthopedics, the platform should address all specialties by early 2017.
Bloqueos nerviosos bajo ultrasonido

Advantages and disadvantages of ultrasound guided

Advantage of ultrasound guided regional anesthesia methods.

  • High success rate
  • Safe performance of blocks
  • Direct visualization of neuronal and adjacent anatomical structures
  • Direct visualization of needle placement and spread of local anesthetics
  • The individual blocks are cheaper in comparison with other techniques in regional anesthesia
  • Amortization of high standard ultrasound equipment after 2500 blocks due to high success rates (with very low conversion rates to alternative anesthesia methods),
femoral nerve blocks in children.

Ultrasonographic guidance for sciatic and femoral nerve blocks in children

BACKGROUND:

Recent studies have shown that ultrasound guidance for paediatric regional anaesthesia can improve the quality of upper extremity and neuraxial blocks. We therefore investigated whether ultrasound guidance for sciatic and femoral nerve blocks prolongs sensory blockade in comparison with nerve stimulator guidance in children.

METHODS: 

Forty-six children scheduled for surgery of one lower extremity were randomized to receive a sciatic and femoral nerve block under either ultrasound or nerve stimulator guidance.

Video referent to Popliteal Sciatic Nerve Block

The items to be considered on the following video are:

  • Block characteristic: Intermediate technique
  • Patient position: Supine, hip and knee flexed, pillow under the ankle
  • Ultrasound equipment: Linear probe, 38 mm
  • Specific ultrasound setting: High frequency
  • Important anatomical structures: Biceps and semi-membranosus muscles, popliteal vessels
  • Ultrasound appearance of the neuronal structures: Main sciatic nerve: hyperechoic,

Video referent to subgluteal nerve block

The items to be considered on the following video are:

  • Block characteristic: Intermediate technique
  • Patient position: Supine, 90º flexed hip and knee or lateral, 45º flexed hip or prone position
  • Ultrasound equipment: Linear probe, 38 mm
  • Specific ultrasound setting: High – medium frequency
  • Important anatomical structures: Adductor magnus muscle,

Video referent to obturator nerve block

The items to be considered on the following video are:

  • Block Characteristic: Intermediate technique
  • Patient Position: Supine, outside rotated leg
  • Ultrasound equipment: Linear Probe
  • Specific Ultrasound Setting: High Frequency
  • Important anatomical Structure: Pectineus, long and short adductor muscles
  • Ultrasound appearance of the neuronal structures: Hyperechoic,

Video referent to femoral nerve block

The items to be considered on the following video are:

  • Block characteristic: Basic technique
  • Patient position: Supine, slightly outside rotated lower extremity
  • Ultrasound equipment: Linear probe 38 mm
  • Specific ultrasound setting: Maximum frequency
  • Important anatomical structures: Femoral artery, iliopectineal arch, psoas major muscle
  • Ultrasound appearance of the neuronal structures: Poor echogenicity,

Ultrasonography Guided Lower Extremity Blocks

Infographics that help us understand the use of USB and USC needles

  • The USB (30º Bevel needles for peripheral nerves blocks under ultrasound guidance) for the research of muscular nerve sheaths was conceived so you can observe them clearly – whilst moving through the tissues – on the screen of an ultra sound machine thanks to a surface treatment of the steel tubing.