Willschke H, Bösenberg A, Marhofer P, Johnston S, Kettner S C, Wanzel O, Kapral S
Department of Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Viena, Austria.
Br J Anaesth. 2006 Aug;97(2):244-9. doi: 10.1093/bja/ael143. Epub 2006 Jun 23.
The purpose of this study was an anatomical and clinical evaluation of ultrasonography-guided rectus sheath blocks in children.
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.
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.
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.
本研究旨在对儿童超声引导下腹直肌鞘阻滞进行解剖学和临床评估。
本研究的超声解剖部分共纳入30名儿童。使用便携式SonSite 180 plus超声仪和5-10MHz线性探头评估腹直肌鞘前后层的深度。本研究的临床部分共纳入20例连续接受脐疝修补术的儿童。全身麻醉诱导后,儿童在实时超声引导下接受腹直肌鞘阻滞,双侧在鞘后层与腹直肌之间的间隙注入0.1ml·kg⁻¹。
所有儿童均能通过超声清晰显示腹直肌鞘后层。腹直肌鞘后层深度与体重(校正r²=0.175)、身高(校正r²=0.314)和体表面积(校正r²=0.241)之间的相关性较差。超声引导下的腹直肌鞘阻滞在所有儿童中均提供了充分的镇痛效果,围手术期无需额外镇痛。
在实时超声引导下,于腹直肌鞘后层与腹直肌之间的间隙双侧注入0.25%左旋布比卡因0.1ml·kg⁻¹,可为脐疝修补术提供充分的镇痛。儿童腹直肌鞘后层深度不可预测,这是在儿童区域麻醉技术中使用超声的一个有力理由。