Feasibility and efficacy of placement of continuous sciatic perineural catheters solely under ultrasound guidance in children: a descriptive study

• Published in: Pediatric anesthesia 2011-04, Vol.21 (4), p.406-410
• Main Authors: Ponde, Vrushali C., Desai, Ankit P., Shah, Dipal M., Johari, Ashok N.
• Format: Article
• Language: English
• Subjects: Analgesics, Opioid - administration & dosage; Analgesics, Opioid - therapeutic use; Anesthetics, Intravenous - administration & dosage; Bupivacaine; catheter; Catheterization - methods; Catheters; Child; Child, Preschool; Children; continuous sciatic block; Drugs; Feasibility Studies; Female; Femoral Nerve - diagnostic imaging; Fentanyl - administration & dosage; Humans; Infant; Male; Nerve Block - methods; Orthopedic Procedures; Pain, Postoperative - drug therapy; Prospective Studies; Sciatic nerve; Sciatic Nerve - diagnostic imaging; Surgery; Talus - surgery; Tramadol - administration & dosage; Tramadol - therapeutic use; tuohy needle; Ultrasonography; Ultrasound; ultrasound guidance
• ISSN: 1155-5645; 1460-9592
• DOI: 10.1111/j.1460-9592.2011.03526.x

Summary Background:  Placement of sciatic catheters with ultrasound and stimulating catheters is known. Literature regarding catheter placements with only ultrasound is limited. We aimed to investigate the feasibility of performing continuous sciatic nerve block exclusively with ultrasound guidance and minimal equipment. Method:  Forty ASA 1 and 2 patients aged 8 months–10 years posted for congenital talipoequinovarus surgery were included in the study. Continuous sciatic catheters were placed under ultrasound guidance with 18‐ gauge Tuohy needle at the infragluteal fold. Then, 0.25% of bupivacaine 0.5 ml·kg−1 bolus was injected followed by continuous infusion later. Half the volume of the drug was injected prior to catheter insertion to improve visibility. The sciatic nerve, needle tip and shaft, catheter tip and the drug spread were visualized. The efficacy of the block intraoperatively and postoperatively was evaluated. Results:  The sciatic nerve, needle shaft, and tip were well visualized in all 40 patients. The catheter tip was seen in 72.5% of patients. The effect of block was complete intraoperatively and postoperatively. Clinically significant complications were absent. Conclusion:  We conclude that in children, continuous sciatic catheters can be accurately and efficaciously placed with minimal equipment with ultrasound alone.