Ultrasound Research Today is a free monthly online journal that collates and summarizes the latest research about Ultrasound, including details on screening, diagnosis, pregnancy, detection.

Ultrasonography-guided rectus sheath block in paediatric anaesthesia--a new approach to an old technique.

Willschke H, Bösenberg A, Marhofer P, Johnston S, Kettner SC, Wanzel O, Kapral S

Department of Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Viena, Austria. harald.willschke@meduniwien.ac.at

BACKGROUND: The purpose of this study was an anatomical and clinical evaluation of ultrasonography-guided rectus sheath blocks in children. METHOD: A total of 30 children were included in the sono-anatomical part of the study. The depth of the anterior and posterior rectus sheath was evaluated with a portable SonSite 180 plus ultrasound machine and a 5-10 MHz linear probe. In total, 20 consecutive children undergoing umbilical hernia repair were included in the clinical part of this study. After induction of general anaesthesia children received a rectus sheath block under real-time ultrasonographic guidance by placing 0.1 ml kg(-1) bilaterally in the space between the posterior aspect of the sheath and the rectus abdominis muscle. RESULTS: Ultrasonographic visualization of the posterior rectus sheath was possible in all children. The correlation between the depth of the posterior rectus sheath and weight (adjusted r(2)=0.175), height (adjusted r(2)=0.314) and body surface area (adjusted r(2)=0.241) was poor. The ultrasound-guided rectus sheath blockade provided sufficient analgesia in all children with no need for additional analgesia in the perioperative period. CONCLUSION: The bilateral placement of levobupivacaine 0.25% 0.1 ml kg(-1) in the space between the posterior aspect of the rectus sheath and the rectus abdominis muscle under real-time ultrasonographic guidance provides sufficient analgesia for umbilical hernia repair. The unpredictable depth of the posterior rectus sheath in children is a good argument for the use of ultrasonography in this regional anaesthetic technique in children.

Published 11 July 2006 in Br J Anaesth, 97(2): 244-9.
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