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BJA Advance Access published online on April 21, 2007
British Journal of Anaesthesia, doi:10.1093/bja/aem092
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Ultrasonographic guidance for sciatic and femoral nerve blocks in children{dagger}

U. Oberndorfer1, P. Marhofer1, A. Bösenberg2, H. Willschke1, M. Felfernig1, M. Weintraud1, S. Kapral1 and S. C. Kettner1,*

1 Department of Anaesthesia and Intensive Care Medicine, Medical University Vienna, Währinger Gürtel 18–20, A-1090 Vienna, Austria
2 Department of Anaesthesia and Intensive Care Medicine, University of Cape Town, Red Cross Children Hospital, Klipfontein Road, Rondebosch 7700, South Africa

* Corresponding author. E-mail: stephan.kettner{at}meduniwien.ac.at

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. After induction of general anaesthesia, the blocks were performed using an ultrasound-guided multiple injection technique until the nerves were surrounded by levobupivacaine, or by nerve stimulator guidance using a predefined dose of 0.3 ml kg–1 of levobupivacaine. An increase in heart rate of more than 15% of baseline during surgery defined a failed block. The duration of the block was determined from the injection of local anaesthetic to the time when the patient received the first postoperative analgesic.

Results: Two blocks in the nerve stimulator group failed. There were no failures in the ultrasound group. The duration of analgesia was longer in the ultrasound group mean (SD) 508 (178) vs 335 (169) min (P < 0.05). The volume of local anaesthetic in sciatic and femoral nerve blocks was reduced with ultrasound compared with nerve stimulator guidance [0.2 (0.06) vs 0.3 ml kg–1 (P < 0.001) and 0.15 (0.04) vs 0.3 ml kg–1 (P < 0.001), respectively].

Conclusions: Ultrasound guidance for sciatic and femoral nerve blocks in children increased the duration of sensory blockade in comparison with nerve stimulator guidance. Prolonged sensory blockade was achieved with smaller volumes of local anaesthetic when using ultrasound guidance.

Keywords: anaesthetic techniques regional, sciatic; children; measurement techniques, ultrasound

{dagger} The study was performed at the Red Cross Children Hospital, Klipfontein Road, Rondebosch 7700, Cape Town, South Africa.


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