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Ultrasound‐guided approach to the paravertebral space for catheter insertion in infants and children
Author(s) -
Boretsky Karen,
Visoiu Mihaela,
Bigeleisen Paul
Publication year - 2013
Publication title -
pediatric anesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.704
H-Index - 82
eISSN - 1460-9592
pISSN - 1155-5645
DOI - 10.1111/pan.12238
Subject(s) - interquartile range , medicine , ultrasound , catheter , surgery , nerve block , anesthesia , nuclear medicine , radiology
Summary Background Paravertebral perineural blocks are used to prevent pain in the thoracoabdominal dermatomes. Traditionally, a landmark‐based technique is used in children, while ultrasound‐guided ( UG ) techniques are being employed in adult patients. Objective To describe an UG technique for placement of thoracic paravertebral nerve block ( TPVNB ) catheters in pediatric patients. Methods Retrospective chart review of a series of 22 pediatric patients' ages 6 months to 17 years with weights from 6.25 kg to 135 kg using a transverse in‐plane technique. Catheters were placed both bilateral and unilateral for a variety of thoracic and abdominal procedures. A linear ultrasound transducer was used in all cases with frequency of oscillation and transducer length chosen based on individual patient characteristics of age, weight, and BMI . Results The median pain scores at 12, 24, 36, and 48 h were 1.2 (interquartile range, 4.5), 0.84 (interquartile range 3.0), 1.6 (interquartile range 2.9), and 0.83 (interquartile range 1.74), respectively. The median dose of opioid expressed as morphine equivalents consumed during the first 24 h after surgery was 0.14 mg·kg −1 (interquartile range, 0.78 mg·kg −1 ) and from 24 to 48 h the median dose was 0.11 mg·kg −1 (interquartile range 0.44 mg·kg −1 ). No complications were noted, and catheters were left an average of 3 days with a range of 1–5 days with good pain relief. Conclusion This technical description demonstrates the feasibility of placing PVNB catheters using a transverse in‐line ultrasound‐guided technique in a wide range of pediatric patients.