Abstract
A four-month old, 4.5kg weight infant with normal mentation was posted for Achilles tendon lengthening for bilateral club foot. Anaesthesia was provided with intrathecal administration of 0.4ml of 0.5% bupivacaine and popliteal sciatic nerve block with 0.2 % bupivacaine 1.5ml to each side. The sciatic nerve was looking hypoechoic than the classical honeycomb possibly due to lesser development of connective tissue. The infant had satisfactory analgesia for 12hrs post-surgery and there was no analgesic requirement. Routine follow up for three months was uneventful. We conclude that intrathecal bupivacaine supplemented with ultrasound guided peripheral nerve blocks can be administered even in infants. As case reports like this are rare to find in literature, we report this case for its uniqueness.
Highlights
Paediatric spinal anaesthesia is a safe alternative to general anaesthesia but often can be the anaesthetic technique of choice in many lower abdominal and lower limb surgeries in children including infants.[1]
A successful management of an infant for lower limb surgery with combined intrathecal and ultrasound guided sciatic nerve block
Marinella Astuto[6] et al reported a case of fivemonth-old, 5kg male infant with Goldenhar syndrome successfully treated with general anaesthesia with laryngeal mask airway and nerve stimulator guided sciatic nerve block in popliteal fossa for club foot surgery
Summary
Paediatric spinal anaesthesia is a safe alternative to general anaesthesia but often can be the anaesthetic technique of choice in many lower abdominal and lower limb surgeries in children including infants.[1] Peripheral nerve blocks in children have been considered challenging due to need for targeting neural structures which often course very close to critical structures and the need for limiting the volume of local anaesthetic solution below toxic levels. Real-time ultrasound imaging improves the ability of the anaesthesiologist to identify the neural elements, place the needle in close proximity to the target and precisely administer optimal volumes of the local anaesthetic.[2] We present, a successful management of an infant for lower limb surgery with combined intrathecal and ultrasound guided sciatic nerve block. The child was followed up for a period of three months and found to have no further complications
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