Ultrasound-guided perineural catheter and local anesthetic infusion in the perioperative management of pediatric limb salvage: a case report.
Local anesthetic perineural infusion has emerged as an effective analgesic technique in pediatric patients, but it can also complement surgical perioperative management in complex cases that require optimal tissue perfusion such as limb salvage. We report the successful use of brachial plexus perineural infusion in the care of a child following near-amputation of her dominant hand. An ultrasound-guided infraclavicular brachial plexus catheter was placed in the recovery room after complex reconstructive surgery and a continuous infusion of 0.2% ropivacaine maintained for 24 days. The resultant sympathectomy was integral to providing distal limb perfusion despite partial restenosis of the surgical revascularization.
Loland
Vanessa J
VJ
Department of Anesthesiology, University of California, San Diego, CA 92103-8770, USA.
Ilfeld
Brian M
BM
Abrams
Reid A
RA
Mariano
Edward R
ER
D000577:Amides / Q000008:administration & dosage / Q000494:pharmacology*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000494:pharmacology*; D001917:Brachial Plexus / Q000000981:diagnostic imaging*; D002404:Catheterization; D002648:Child; D005260:Female; D006083:Graft Occlusion, Vascular / Q000150:complications; D006225:Hand / Q000098:blood supply / Q000601:surgery; D006230:Hand Injuries / Q000601:surgery*; D006801:Humans; D023821:Limb Salvage / Q000379:methods*; D009407:Nerve Block / Q000379:methods*; D010523:Peripheral Nervous System Diseases / Q000209:etiology / Q000628:therapy; D019651:Plastic Surgery Procedures; D012039:Regional Blood Flow; D000077212:Ropivacaine; D016038:Skin Transplantation; D014463:Ultrasonography
D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine