Ultrasound Blocks for the Anterior Abdominal Wall

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46 | Ultrasound Blocks for the Anterior Abdominal Wall Table 4.1 – Pediatric distances in millimeters (mean ± SD) (modified from van Schoor 2005, Willschke 2005 and Hong 2010). Neonates ASIS to left IIN 1.9 ± 0.9, (01 to 0.61) ASIS to right IIN 2.0 ± 0.7, (3.44 to 0.49) Children ASIS to left IIN 3.3 ± 0.8, (5.31 to 1.52) 1 months - 8 years ASIS to right IIN 3.9 ± 1.0, (5.39 to 2.36) ASIS to IIN 6.7 ± 2.9 Skin to IIN 8.0 ± 2.2 IIN to peritoneum 3.3 ± 1.3 (1–4.6) 0-12 months ASIS to IIN 8.7±2.1 ASIS to IHN 9.8±2.6 Skin to IIN 8.7±1.9 Skin to IHN 9.8±1.9 IIN to peritoneum 8.5±1.7 IIH to peritoneum 9.0±1.7 12-36 months ASIS to IIN 11.6±3.0 ASIS to IHN 13.2±2.6 Skin to IIN 9.2±1.7 Skin to IHN 9.7±2.0 IIN to peritoneum 6.3±4.1 IIH to peritoneum 4.1±1.8 > 37 months ASIS to IIN 15.2±3.7 ASIS IHN 18.0±4.3 Skin to IIN 6.5±3.3 Skin to IHN 3.8±1.5 IIN to peritoneum 7.3±4.1 IIH to peritoneum 4.5±1.7 Blind techniques may be confusing because of imprecise description and insufficient understanding. There is also a high potential for complications such as peritoneal or visceral puncture (Weintraud 2008, van Schoor 2005). The reported failure rate remains high and variable, 6 to 43%, even in
4. Iliohypogastric and Ilioinguinal Nerve Block | 47 experienced hands or when multiple punctures are performed because of the high anatomical and landmark variability (Randhawa 2010). The failure rate may be as high as 6 to 40% especially in infants and children, even when the nerve is exposed at surgery (Weintraud 2008, Lim 2002). Correct administration of local anesthetic around the target nerves occurred in only 14% and 57% of cases in two studies when using a landmark method with a fascial click (Weintraud 2008, Randhawa 2010). The remainder of the injections were deposited in adjacent anatomical structures (iliac muscle 18%, TAM 26%, IOM 29%, EOM 9%, subcutaneous tissue 2%, and peritoneum 2%) (Weintraud 2008). The data in Table 4.1 show the distances from the skin and the ASIS to the nerves and from the nerves to the peritoneum in children. Table 4.2 show the abdominal muscle size in adults. Table 4.2 – Adult distances in centimeters (modified from Eichenberger 2006 and Rankin 2006). Adults Absolute abdominal muscle size at the mid-axillary line Males 3.86 (right: 0.64, 95% range 2.58–5.14) 0.4–1.1 3.88 (left: 0.67, 95% range 2.54–5.22) Females 2.96 (right: 0.46, 95% range 2.04–3.88) 0.4–1.1 2.94 (left: 0.43, 95% range 2.08–3.80) IIN to bone distance at the ASIS These data highlight the fact that blind techniques may be imprecise and carry a high risk of bowel, liver or spleen puncture, especially in children. Needle depth should be confirmed by the fascial click, since the risk increases if the needle is introduced too deep when the ‘pop’ is not identified (Hong 2010). There is a weak correlation between weight and the depth of the IIN (Willschke 2005). These findings emphasize the usefulness of ultrasounds for this block technique and the fact that needle tip visualization is mandatory (Weintraud 2008).
Page 1 and 2: the Flying Publisher Guide to Ultra
Page 3 and 4: Zhirajr Mokini Giovanni Vitale Amed
Page 5 and 6: | 5 Preface Somatic post-surgical p
Page 7 and 8: | 7 Savino Spadaro Department of Ex
Page 9 and 10: | 9 Table of Contents 1. Anatomy fo
Page 11 and 12: | 11 Pediatric Considerations......
Page 13 and 14: 1. Anatomy for Anesthesiologists |
Page 25 and 26: 2. Ultrasound and Regional Anesthes
Page 35 and 36: 3. Transverse Abdominal Plexus Bloc
Page 45: 4. Iliohypogastric and Ilioinguinal
Page 49 and 50: 4. Iliohypogastric and Ilioinguinal
Page 51 and 52: 4. Iliohypogastric and Ilioinguinal
Page 53 and 54: 5. Genitofemoral Nerve Block Zhiraj
Page 55 and 56: 5. Genitofemoral Nerve Block | 55 s
Page 57 and 58: 5. Genitofemoral Nerve Block | 57 p
Page 59 and 60: 5. Genitofemoral Nerve Block | 59 e
Page 61 and 62: 6. Rectus Sheath Block | 61 Figure
Page 63 and 64: 6. Rectus Sheath Block | 63 Table 6
Page 65 and 66: 7. Inguinal Hernia Repair Roberto F
Page 67 and 68: 7. Inguinal Hernia Repair | 67 comp
Page 69 and 70: 7. Inguinal Hernia Repair | 69 Ilio
Page 71 and 72: 8. Inguinal Surgery in Children Giu
Page 73 and 74: 8. Inguinal Surgery in Children | 7
Page 75 and 76: 9. Obstetric and Gynecologic Surger
Page 77 and 78: 9. Obstetric and Gynecologic Surger
Page 79 and 80: 10. Other Abdominal Surgery Procedu
Page 81 and 82: 10. Other Abdominal Surgery Procedu
Page 83 and 84: 11. Abdominal Midline Surgery Savin
Page 85 and 86: 12. Local Anesthetics, Pharmacokine
Page 91 and 92: 13. Complications | 91 13. Complica
Page 93 and 94: 13. Complications | 93 Peritoneal a
Page 95 and 96: 13. Complications | 95 Figure 13.2
Page 97 and 98:
14. References | 97 14. References
Page 99 and 100:
14. References | 99 Caetano AM, Fal
Page 101 and 102:
14. References | 101 Fredrickson M,
Page 103 and 104:
14. References | 103 Kark AE, Kurze
Page 105 and 106:
14. References | 105 (3) McDonnell
Page 107 and 108:
14. References | 107 Rankin G, Stok
Page 109 and 110:
14. References | 109 Toivonen J, Pe
Page 111 and 112:
15. Index | 111 15. Index Index abs
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Ultrasound Blocks for the Anterior Abdominal Wall

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