Are peripheral and neuraxial blocks with ultrasound guidance more effective and safe in children?
OBJECTIVE
The efficacy and safety of ultrasound guided (USG) pediatric peripheral nerve and neuraxial blocks in children have not been evaluated. In this review, we have looked at the success rate, efficacy and complications with USG peripheral nerve blocks and compared with nerve stimulation or anatomical landmark based techniques in children.


METHODS
All suitable studies in MEDLINE, EMBASE Drugs and Cochrane Evidence Based Medicine Reviews: Cochrane Database of Systemic Reviews databases were identified. In addition, citation review and hand search of recent pediatric anesthesia and surgical journals were done. All three authors read all selected articles independently and a consensus was achieved. All randomized controlled trials (RCTs) comparing USG peripheral and neuraxial blocks with other techniques in children were included.


RESULTS
Ultrasound guidance has been demonstrated to improve block characteristics in children including shorter block performance time, higher success rates, shorter onset time, longer block duration, less volume of local anesthetic agents and visibility of neuraxial structures.


CONCLUSIONS
Clinical studies in children suggest that US guidance has some advantages over more traditional nerve stimulation-based techniques for regional block. However, the advantage of US guidance on safety over traditional has not been adequately demonstrated in children except ilio-inguinal blocks.
Rubin
Kasia
K
Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
Sullivan
Denise
D
Sadhasivam
Senthilkumar
S
D000779:Anesthetics, Local; D001917:Brachial Plexus / Q000000981:diagnostic imaging; D002648:Child; D004558:Electric Stimulation / Q000379:methods; D006801:Humans; D009407:Nerve Block / Q000009:adverse effects / Q000379:methods*; D010525:Peripheral Nerves / Q000000981:diagnostic imaging; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods*
D000779:Anesthetics, Local