Regional Anesthesia for Children in the Twenty-First Century
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PEDIATRIC ANESTHESIA (J LERMAN, SECTION EDITOR)
Regional Anesthesia for Children in the Twenty-First Century Amod Sawardekar • Santhanam Suresh
Published online: 7 December 2012 Springer Science + Business Media New York 2012
Abstract The use of regional anesthesia in children is increasing. The advancements in the use of ultrasonography have allowed peripheral regional anesthetic techniques to be completed with greater ease in pediatrics. Nerve stimulation continues to be an important tool in completing blocks. Currently, there is limited evidence to determine if the use of ultrasonography reduces the total dose of local anesthetic needed for successful nerve blockade or has additional safety benefits in pediatrics. Whichever technique is chosen, successful peripheral nerve blockade provides children with pain relief, potentially eliminating opioid use and associated unwanted side effects, leading to an improved operative experience for both children and their families.
children provides clear identification of the local anatomy, which has facilitated effective and safe peripheral nerve blockade in children. In contrast to adults, regional anesthesia is performed after the children are anesthetized [1•, 2]. Although central neuraxial blockade remains an essential component in providing perioperative and postoperative analgesia, this article focuses on the use of peripheral regional anesthesia in children including techniques and potential complications.
Keywords Peripheral nerve blockade Pediatric regional anesthesia Peripheral nerve catheter Nerve stimulation Ultrasound guided regional anesthesia
Blockade of the brachial plexus via the axillary approach provides analgesia to the elbow, forearm, and hand. The radial, median, and ulnar nerves can be blocked in the axilla with a single needle insertion. The radial nerve commonly lies posterior to the axillary artery whereas the ulnar nerve lies anterior and inferior to the artery. The median nerve is usually located anterior and superior to the axillary artery [3]. The musculocutaneous nerve lies outside the neurovascular sheath in the axilla, between the biceps brachii and coracobrachialis muscles, and must be blocked separately (see Fig. 1).
Introduction Regional anesthesia in pediatrics is increasing in popularity with the widespread availability and advanced use of ultrasonography as well as accepted techniques of nerve stimulation. Ultrasound-guided regional anesthesia in
Axillary Block Anatomy and Indications
Technique A. Sawardekar (&) S. Suresh Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Feinberg School of Medicine, Northwestern University, 225 East Chicago Avenue, Box 19, Chicago, IL 60611, USA e-mail: [email protected] S. Suresh e-mail: [email protected]
Ultrasound-guided axillary blockade in children are not well described in the literature, but techniques used in adults can be applied to children [4, 5]. An out-of-plane technique is utilized with the ultrasound pr
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