title: Ultrasound-guided umbilical nerve block in children: a brief description of a new approach.
abstract: BACKGROUND
  The most popular peripheral nerve blocks used in umbilical hernia repair are rectus sheath block and paraumbilical block. However, multiple anatomic variations have been described and some complications may occur. Ultrasonographic guidance of peripheral nerve blocks has reduced the number of complications and improved the quality of blocks. This case series describes a new ultrasound-guided puncture technique of the 10th intercostal nerve in pediatric umbilical surgery.
  
  
  METHODS
  Ten children (age range: 2-5 years) scheduled for umbilical hernia repair were included. Following the induction of general anesthesia, the ultrasonographic anatomy of the umbilical region was studied with a 10-MHz linear probe. An ultrasound-guided peripheral block of the 10th intercostal nerve in the lateral edge of both rectus abdominis muscles (RMs) was performed (total of 20 punctures). Surgical conditions, intraoperative hemodynamic parameters, and postoperative analgesia by means of the modified CHEOPS scale were evaluated.
  
  
  RESULTS
  Umbilical anatomy was clearly identified by ultrasound in all cases. The epigastric vessels were identified--above the umbilicus--within the depth of the muscular mass of the RM. The spread of local anesthetic was ultrasound-controlled in all cases. However, the intercostal nerve could not be visualized. All blocks were effective during the surgery. Postoperative analgesia was only required in two children in the second postoperative hour. There were no complications.
  
  
  CONCLUSIONS
  Ultrasound guidance enables performance of an effective umbilical block in the lateral edge of RM. Further studies should be carried on to visualize the intercostal nerve and to compare this technique with the classical ones.
authors.affiliation: Department of Pediatric Anesthesiology, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain. bdejosemaria@hsjdbcn.org
authors.forename: Belen
authors.initials: B
authors.lastname: de Jose Maria
authors.forename: Victor
authors.initials: V
authors.lastname: Götzens
authors.forename: Maged
authors.initials: M
authors.lastname: Mabrok
mesh_terms: D000768:Anesthesia, General / Q000379:methods; D002675:Child, Preschool; D005260:Female; D006554:Hernia, Umbilical / Q000601:surgery*; D006801:Humans; D007367:Intercostal Nerves / Q000187:drug effects; D008297:Male; D009407:Nerve Block / Q000009:adverse effects / Q000379:methods*; D017568:Rectus Abdominis / Q000000981:diagnostic imaging / Q000294:innervation; D018084:Ultrasonography, Interventional / Q000009:adverse effects / Q000379:methods*; D014472:Umbilicus / Q000000981:diagnostic imaging* / Q000294:innervation / Q000601:surgery