Ultrasound‐guided approach to the paravertebral space for catheter insertion in infants and children

Abstract

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. To describe an UG technique for placement of thoracic paravertebral nerve block (TPVNB) catheters in pediatric patients. Retrospective chart review of a series of 22 pediatric patients' ages 6months to 17years with weights from 6.25kg to 135kg 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. The median pain scores at 12, 24, 36, and 48h 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 24h after surgery was 0.14mg·kg(-1) (interquartile range, 0.78mg·kg(-1) ) and from 24 to 48h the median dose was 0.11mg·kg(-1) (interquartile range 0.44mg·kg(-1) ). No complications were noted, and catheters were left an average of 3days with a range of 1-5days with good pain relief. 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.