RESUMEN
BACKGROUND AND AIMS: Intraabdominal hypertension (IAH) is poorly diagnosed condition that cause splanchnic hypoperfusion and abdominal organs ischemia and can lead to multiple organ failure. There are no scientific data regarding effect of intraabdominal pressure (IAP) on splanchnic circulation in children. MATERIAL AND METHODS: Ninety-four children after surgery for appendicular peritonitis were enrolled in the study. After IAP measurement children were included in one of two groups according IAP levels: "without IAH" (n = 51) and "with IAH" (n = 43). Superior mesenteric artery (SMA) and portal vein (PV) blood flows (BFSMA, BFPV, mL/min) were measured, and SMA and PV blood flow indexes (BFISMA, BFIPV, ml/min*m2) and abdominal perfusion pressure (APP) were calculated in both groups. RESULTS: Median BFISMA and BFIPV in group "with IAH" were lower by 54.38% (P < 0.01) and 63.11% (P < 0.01) respectively compared to group "without IAH". There were strong significant negative correlation between IAP and BFISMA (r s = -0.66; P < 0.0001), weak significant negative correlation between IAP and BFIPV (r s = -0.36; P = 0.0001) in group "with IAH" and weak significant negative correlation between IAP and BFISMA (r s = -0.30; P = 0.0047) in group "without IAH". There were no statistically significant correlations between IAP and BFIPV in group "without IAH", between BFISMA and APP in both groups and between BFIPV and APP in both groups. CONCLUSION: Elevated IAP significantly reduces splanchnic blood flow in children with appendicular peritonitis. BFISMA and BFIPV negatively correlate with IAP in these patients. There is no correlation between BFISMA/BFIPV and APP in children with IAH due to appendicular peritonitis.
RESUMEN
BACKGROUND: Rectus sheath block (RSB) is a valuable regional technique for abdominal wall midline analgesia. It can be used for a variety of surgical procedures such as midline laparotomy, umbilical and paraumbilical hernia repair, and laparoscopic surgery. Not all operating theatres, especially in low income countries, are equipped with ultrasound (US) scanners for carrying out US guided regional blocks. In cases of total absence of objective control, neurostimulator (NS) guided technique of RSB can be useful. The aim of the study was to assess the feasibility of performing NS guided RSB. METHODS: US guided RSB with NS was performed on patients in group 1. NS guided RSB was performed on patients in group 2. US scanning of block area and clinical efficacy assessment were performed in group 2. RESULTS: In group 1 in all cases of US guided RSB with NS, needle entry into the rectus abdominis muscle resulted in its contractions and needle contact with the posterior sheath resulted in cessation of these contractions. In group 2 optimal spread of local anesthetic was achieved in 86 cases (74.14%), and suboptimal spread in 30 cases (25.86%) of NS guided RSB. There were no cases of non-optimal local anesthetic spread. In all cases NS guided RSB had high clinical efficacy (there was no motor response to incision and no need for fentanyl administration). CONCLUSIONS: Rectus sheath block can be performed under neurostimulator guidance. Neurostimulator guided rectus sheath block results in optimal or suboptimal local anes-thetic spread. Clinical efficacy of neurostimulator guided rectus sheath block is high. The trial is registered as ACTRN12618000553279 (http://www.ANZCTR.org.au/ACTRN12618 000553279.aspx).
Asunto(s)
Anestésicos Locales/administración & dosificación , Bloqueo Nervioso/métodos , Ultrasonografía Intervencional/métodos , Niño , Preescolar , Estimulación Eléctrica/métodos , Estudios de Factibilidad , Femenino , Humanos , Lactante , Masculino , Recto del AbdomenRESUMEN
BACKGROUND: Sciatic and femoral nerve blocks (SNB and FNB) result in effective lower limb analgesia. Classical SNB and FNB require patient repositioning which can cause pain and discomfort. Alternative approaches to sciatic and femoral nerve blocks in supine patients can be useful. MATERIALS AND METHODS: Neurostimulator-guided SNB and FNB from the lateral supratrochanteric approach were performed. Local anesthetic spread in SNB and FNB after radiographic opacification was analyzed. Time and number of attempts to perform blocks, needle depth, and clinical efficacy were assessed. RESULTS: Mean needle passes number and procedure time for SNB were 2.5 ± 0.3 and 2.4 ± 0.2 min, respectively. Mean needle passes number and procedure time for FNB were 2.7 ± 0.27 and 2.59 ± 0.23 min, respectively. Mean skin to nerve distance was 9.1 ± 0.45 cm for SNB and 8.8 ± 0.5 cm for FNB. Radiographic opacification of SNB showed local anesthetic spread close to the sacrum and involvement of sacral plexus nerve roots. Spread of local anesthetic in FNB was typical. Intraoperative fentanyl administration was required in 2 patients (9.5%) with mean dose 1.8 ± 0.2 mcg/kg. Mean postoperative pain score was 0.34 ± 0.08 of 10. CONCLUSION: The lateral supratrochanteric approach to SNB and FNB in children can be an effective lower limb analgesic technique in supine patients. The trial is registered with ISRCTN70969666.
RESUMEN
BACKGROUND: Thoracolumbar paravertebral block (PVB) is one method of providing regional anaesthesia for abdominal wall surgery in children. It is common practice when performing a PVB for abdominal wall anaesthesia to inject a certain volume of local anaesthetic solution in the paravertebral space at several levels. This increases the duration of the procedure and makes it more invasive. OBJECTIVES: To determine the character of dye spread in infants' paravertebral space, to check the feasibility of single injection PVB and to determine the optimal volume of injectate necessary to cover the paravertebral segments responsible for sensation of the lower abdomen. DESIGN: Experimental study. SETTING: Single centre, University Hospital, April 2013 to August 2013. SUBJECTS: Twenty infant cadavers. INTERVENTION: Ultrasound-guided, single thoracolumbar paravertebral injections were performed on infant cadavers. MAIN OUTCOME MEASURE: The total number of paravertebral segments stained after dye injection and specific vertebral levels of cephalad and caudad spread of dye in the paravertebral space. RESULTS: Dye was present in the paravertebral spaces of all cadavers. Spread of dye within the paravertebral space was different depending on dye volume. Strong correlation was found between the volume of injectate and the number of paravertebral segments involved. The number of spinal nerve roots surrounded with dye corresponded with the number of paravertebral segments involved. T11, T12 and L1 nerve roots were stained in all cadavers. The optimal injectate volume to involve T10-L1 segments was defined as 0.2 to 0.3 âmlâ kg(-1). CONCLUSION: Single thoracolumbar paravertebral injection at T12-L1 level leads to caudad and cephalad spread of injectate in a dose-dependent manner. Single injection thoracolumbar paravertebral injections could be performed for lower abdomen anaesthesia in infants. We suggest that a single injection of 0.2 to 0.3â ml âkg(-1) of local anaesthetic in the thoracolumbar paravertebral space could provide adequate coverage of the dermatomes of the lower abdomen.