title: 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.affiliation: Children's Orthopaedic Centre, All India Institute of Physical Medicine and Rehabilitation, Bombay, India. lakshmi1@hotmail.com
authors.forename: Lakshmi
authors.initials: L
authors.lastname: Vas
mesh_terms: D000768:Anesthesia, General; D002648:Child; D002675:Child, Preschool; D005528:Foot / Q000601:surgery*; D006801:Humans; D007223:Infant; D007866:Leg / Q000601:surgery*; D009407:Nerve Block / Q000379:methods*; D012189:Retrospective Studies; D012584:Sciatic Nerve