Continuous sciatic block for leg and foot surgery in 160 children.

Abstract

BACKGROUND:

The aim of this study was to assess the safety and efficacy of continuous sciatic block for lower limb surgery in children.

METHODS:

A total of 160 pediatric patients aged 4 months to 12 years weighing 3.5-50 kg, were given continuous sciatic block plus single shot 3-in-1 block for leg and foot surgery. After general anesthesia, the sciatic nerve was located by using loss of resistance to saline by the mid-thigh approach. An 18 gauge epidural needle was introduced at the junction of the proximal two-third with the distal one-third of a line extending from the apex of popliteal triangle to the midpoint of the line joining the greater trochanter and the ischial tuberosity. A 20 g catheter was threaded through the needle for 5-10 cm and 0.25% bupivacaine 0.75 ml.kg(-1) was injected. A single shot 3-in-1 block was also given to facilitate the use of a tourniquet with 0.25% bupivacaine 0.25 ml. In 20 patients a nerve stimulator was used in addition to loss of resistance. The intraoperative sedation comprised propofol and ketamine infusions and 50% nitrous oxide in oxygen by LMA.

RESULTS:

Eight-two percent of patients showed no response to surgery; 14% patients showed some response to the medial incision over the ankle and needed additional bolus doses of ketamine and propofol. Block was considered to have failed in 4% who required an increase in propofol and ketamine infusions. A total of 154 patients had good postoperative pain relief for 72 h with continuous infusion of 0.05% bupivacaine. The other six were given oral codeine and diclofenac. There were no complications attributable to sciatic block in any patient.

CONCLUSIONS:

Sciatic block with a single shot 3-in-1 block for tourniquet pain and light general anesthesia provides good intraoperative conditions for leg and foot surgery and adequate postoperative pain relief. Additional sedation to minimize the discomfort of a cast may be a consideration in the first 24 h.

• Authors: Lakshmi Vas
• Journal: Paediatric anaesthesia (Paediatr Anaesth) Vol. 15 Issue 11 Pg. 971-8 (Nov 2005) ISSN: 1155-5645 [Print] France
• PMID: 16238559 (Publication Type: Journal Article)

Topics

• Anesthesia, General
• Child
• Child, Preschool
• Foot (surgery)
• Humans
• Infant
• Leg (surgery)
• Nerve Block (methods)
• Retrospective Studies
• Sciatic Nerve