Hadzic's Regional Anesthesia > Part V. Ultrasound-Guided Regional Anesthesia > Chapter 52. Ultrasound-Guided Peripheral Nerve Blocks in Children Peter Marhofer, MD, Stephan Kapral, MD

Ultrasound-Guided Peripheral Nerve Blocks in Children: Introduction

"Modern pediatric anesthesia would not be conceivable without the use of regional anesthetic techniques. For instance, regional anesthesia decreases the need for mechanical ventilation following major thoracic or abdominal surgery. In addition, the need for intraoperative and postoperative opioids decreases accordingly. Perhaps most importantly, the entire perioperative experience is less stressful for children whose perioperative pain is adequately managed. Most of the advantages of perioperative regional anesthesia are demonstrated in central neuraxial blocks, specifically for caudal continuous lumbar or thoracic epidural blocks.Most blocks can be performed with 5- to 10-MHz linear ultrasound transducers. In addition, small probes are required due to the narrow anatomic relationships in children. "Hockey-stick" probes, with a surface length of 25 mm, are particularly well suited for this purpose. Also, higher frequency transducers are available for portable ultrasound units. Theoretically, superficial nerve structures can be better visualized using these higher frequencies. The discussion of techniques in the following sections, however, is based on ultrasound probes working at somewhat lower frequencies. Lower frequencies are preferable for deeper blocks, such as psoas compartment blocks in larger children, because the nerve structures to be visualized are located deeper in this situation. Therefore, we use 2- to 4-MHz sector transducers for this specific indication.Image Depth. It is necessary to strike..."