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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Ilioinguinal/iliohypogastric blocks in children: Where do we administer the local anesthetic without direct visualization?
Anesthesia and Analgesia, Volume 106, No. 1, Year 2008
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Description
BACKGROUND: Ultrasonographic observation of peripheral nerve blocks enables direct visualization of the spread of local anesthetic around the targeted nerves. Similarly, ultrasonography may be used to determine the site of local anesthetic placement when landmark-based techniques are used. We performed a study to determine the actual location of local anesthetic when ilioinguinal/iliohypogastric nerve blocks are performed using landmark-based techniques in children in an attempt to explain a failed block. METHODS: After induction of general anesthesia (1 minimum alveolar anesthetic concentration halothane and laryngeal mask airway), 62 children scheduled for inguinal surgery received an ilioinguinal/iliohypogastric nerve block based on standard anatomical landmarks. Ultrasonography was then used to determine the actual location of local anesthetic placement. The anesthesiologist performing the block was blinded to the ultrasonographic investigation. Successful blocks were recorded either when the local anesthetic surrounded the nerves or were based on clinical signs after skin incision. RESULTS: In 14% of the blocks, the local anesthetic was administered correctly around the nerves resulting in successful blocks. In the remaining 86%, the local anesthetic was administered in adjacent anatomical structures (iliac muscle 18%, transverse abdominal muscle 26%, internal oblique abdominal muscle 29%, external oblique abdominal muscle 9%, subcutaneous 2%, and peritoneum 2%), and 45% of these blocks failed. CONCLUSION: Accurate placement of local anesthetic around the ilioinguinal/iliohypogastric nerves in children is seldom possible when landmark-based techniques are used. In the majority of patients, the local anesthetic was inaccurately placed in adjacent anatomical structures with unpredictable block results. © 2008 by International Anesthesia Research Society.
Authors & Co-Authors
Weintraud, Marion
Austria, Vienna
Medizinische Universität Wien
Marhofer, Peter
Austria, Vienna
Medizinische Universität Wien
Bösenberg, Adrian Thomas
South Africa, Cape Town
University of Cape Town
Kapral, Stephan
Austria, Vienna
Medizinische Universität Wien
Willschke, Harald
Austria, Vienna
Medizinische Universität Wien
Felfernig, Michael
United Kingdom, Yarmouth
Royal Naval Hospital
Kettner, Stephan C.
Austria, Vienna
Medizinische Universität Wien
Statistics
Citations: 189
Authors: 7
Affiliations: 3
Identifiers
Doi:
10.1213/01.ane.0000287679.48530.5f
ISSN:
00032999
Research Areas
Health System And Policy
Maternal And Child Health