RT Book, Section
A1 Vecchione, Tricia
A2 Ellinas, Herodotos
A2 Matthes, Kai
A2 Alrayashi, Walid
A2 Bilge, Aykut
SR Print(0)
ID 1176459485
T1 Regional Anesthesia: Upper and Lower Extremity Blocks
T2 Clinical Pediatric Anesthesiology
YR 2021
FD 2021
PB McGraw Hill
PP New York, NY
SN 9781259585746
LK accessanesthesiology.mhmedical.com/content.aspx?aid=1176459485
RD 2024/04/23
AB FOCUS  POINTSContrary  to  adults,  most  pediatric  peripheral  nerve  blocks  are  placed  under  general  anesthesia.Peripheral  nerve  block  techniques  in  children  are  primarily  used  as  an  adjunct  to  general  anesthesia  for  posteroperative  analgesia.The  greatest  immediate  risk  of  peripheral  nerve  blocks  is  local  anesthetic  systemic  toxicity  from  inadvertent  intravascular  injection.The  interscalene  block  is  most  optimal  for  procedures  of  the  shoulder.  It  may  not  be  ideal  for  procedures  of  the  forearm  and  hand  because  of  the  chance  of  ulnar  sparing.The  supraclavicular  block  provides  a  dense  blockade  from  the  humerus  to  the  hand.The  infraclavicular  block  provides  good  analgesia  from  the  humerus  to  the  hand  and  is  conducive  for  indwelling  catheter  placement.The  axillary  approach  to  the  brachial  plexus  is  optimal  for  procedures  distal  to  the  elbow.  It  misses  the  musculocutaneous  nerve,  which  needs  to  be  blocked  separately.The  femoral  nerve  block  can  be  used  for  many  surgical  techniques  involving  the  thigh  and  knee,  such  as  skin  grafts,  mid  to  distal  femur  osteotomies,  and  knee  arthroscopies.  It  can  also  serve  as  an  adjunct  to  procedures  distal  to  the  knee  requiring  analgesia  to  the  medial  aspect,  which  is  innervated  by  the  saphenous  nerve.The  sciatic  nerve  can  be  blocked  at  multiple  locations  along  its  course.  It  is  useful  for  surgical  procedures  of  the  hip,  thigh,  and  knee.  It  is  very  useful  for  procedures  of  the  distal  lower  extremity  but  needs  to  be  supplemented  with  a  saphenous  nerve  block  for  complete  analgesia.The  lumbar  plexus  provides  coverage  of  three  peripheral  nerves  (femoral,  obturator,  and  lateral  femoral  cutaneous)  at  a  very  proximal  location,  making  it  a  good  block  for  proximal  femur  and  hip  procedures.