title: Ultrasound-guided approach to the paravertebral space for catheter insertion in infants and children.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  To describe an UG technique for placement of thoracic paravertebral nerve block (TPVNB) catheters in pediatric patients.
  
  
  METHODS
  Retrospective chart review of a series of 22 pediatric patients' ages 6 months to 17 years with weights from 6.25 kg to 135 kg 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.
  
  
  RESULTS
  The median pain scores at 12, 24, 36, and 48 h 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 24 h after surgery was 0.14 mg·kg(-1) (interquartile range, 0.78 mg·kg(-1) ) and from 24 to 48 h the median dose was 0.11 mg·kg(-1) (interquartile range 0.44 mg·kg(-1) ). No complications were noted, and catheters were left an average of 3 days with a range of 1-5 days with good pain relief.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Anesthesiology Perioperative and Pain Medicine, Children's Hospital of Boston, Boston, MA, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Boretsky
authors.forename: Mihaela
authors.initials: M
authors.lastname: Visoiu
authors.forename: Paul
authors.initials: P
authors.lastname: Bigeleisen
mesh_terms: D000293:Adolescent; D000768:Anesthesia, General; D000775:Anesthesia, Spinal / Q000379:methods*; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009294:Narcotics / Q000008:administration & dosage / Q000627:therapeutic use; D009407:Nerve Block / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy; D013131:Spine / Q000000981:diagnostic imaging*; D018084:Ultrasonography, Interventional / Q000379:methods*
chemical_list: D009294:Narcotics
keywords: children; infants; postoperative pain; regional anesthesia; ultrasound