Ultrasonography-guided rectus sheath block in paediatric anaesthesia--a new approach to an old technique.

Full Abstract

BACKGROUND:
The purpose of this study was an anatomical and clinical evaluation of ultrasonography-guided rectus sheath blocks in children.

METHOD:
A total of 30 children were included in the sono-anatomical part of the study. The depth of the anterior and posterior rectus sheath was evaluated with a portable SonSite 180 plus ultrasound machine and a 5-10 MHz linear probe. In total, 20 consecutive children undergoing umbilical hernia repair were included in the clinical part of this study. After induction of general anaesthesia children received a rectus sheath block under real-time ultrasonographic guidance by placing 0.1 ml kg(-1) bilaterally in the space between the posterior aspect of the sheath and the rectus abdominis muscle.

RESULTS:
Ultrasonographic visualization of the posterior rectus sheath was possible in all children. The correlation between the depth of the posterior rectus sheath and weight (adjusted r(2)=0.175), height (adjusted r(2)=0.314) and body surface area (adjusted r(2)=0.241) was poor. The ultrasound-guided rectus sheath blockade provided sufficient analgesia in all children with no need for additional analgesia in the perioperative period.

CONCLUSION:
The bilateral placement of levobupivacaine 0.25% 0.1 ml kg(-1) in the space between the posterior aspect of the rectus sheath and the rectus abdominis muscle under real-time ultrasonographic guidance provides sufficient analgesia for umbilical hernia repair. The unpredictable depth of the posterior rectus sheath in children is a good argument for the use of ultrasonography in this regional anaesthetic technique in children.

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Author information

Author/s: Willschke, H (H); Bösenberg, A (A); Marhofer, P (P); Johnston, S (S); Kettner, S C (SC); Wanzel, O (O); Kapral, S (S);

Affiliation: Department of Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Viena, Austria. harald.willschke(-atsign-)meduniwien.ac.at

Journal and publication information

Publication Type: Journal Article

Journal: British journal of anaesthesia (Br J Anaesth), published in England. (Language: eng)

Reference: 2006-Aug; vol 97 (issue 2) : pp 244-9

Dates: Created 2006/07/11; Completed 2006/08/21;

PMID: 16798774, status: MEDLINE (last retrieval date: 12/26/2008)

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Abdomen - ultrasonography
Anesthetics, Local
Blood Pressure - physiology
Bupivacaine - analogs & derivatives
Child
Child, Preschool
Heart Rate - physiology
Hernia, Umbilical - surgery

Associated Chemicals: Anesthetics, Local (0) ; levobupivacaine (0) ; Bupivacaine (2180-92-9)

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