Clinical Pathways
Clinical Pathways
Ultrasound-Guided Nerve Blocks - Pediatric
Ultrasound-Guided Nerve Blocks - Pediatric

Ultrasound-Guided Nerve Blocks - Pediatric

Tags
Ped. Emerg. Med. Practice
Published
May 1, 2022
Author(s)
William White, MD; Lilly Bellman, MD, FAAP; Yiju Teresa Liu, MD

View The Full Pathway

Action

Patient presents with painful condition (fracture, burn, abscess, laceration)

Decision

Perform both steps:

Background

Patient Selection and Preparation

The developmental stage of the patient and the availability of personnel to assist with the procedure are key factors for success. There are no recommended age cutoffs for use of peripheral nerve blocks, but there is also ongoing concern for undertreatment of pain, particularly in infants and young children.7^{7} The youngest age reported in the literature was an ultrasound-guided femoral nerve block for a 3-month-old patient with a femur fracture secondary to nonaccidental trauma.8^{8} Procedural sedation can be considered to facilitate a nerve block if the benefits outweigh the risks.9^{9} Of note, there is a higher risk for local anesthetic systemic toxicity (LAST) in infants aged <1 year.10^{10}

Managing procedural pain and anxiety are priorities in pediatric care.11^{11} Additionally, a calm and comfortable patient maximizes procedural success. Multimodal approaches are best, including developmentally appropriate distraction and procedural support; pharmacologic anxiolysis and topical anesthetics can also be employed in anticipation of a nerve block procedure. When available, child-life specialists can be instrumental in optimizing these factors.12^{12} Parents and caretakers also can be involved in providing a supportive environment for the child and helping with comfort holds.

Topical anesthetics such as eutectic mixture of local anesthetics (EMLA), topical lidocaine 4% cream, jet-administered lidocaine with J-tip®, a wheal of lidocaine, and adjuncts such as vapocoolant spray and Buzzy® can help reduce pain and improve tolerance of needle-involving procedures.11^{11} For more information on management of pediatric pain using these techniques, see the August 2019 issue of Pediatric Emergency Medicine Practice, “Pediatric Pain Management in the Emergency Department.”

If performing an ultrasound-guided block, identify sonographic landmarks and plan the puncture site prior to applying topical anesthetics or administering local lidocaine.

‣
References
  1. Weingarten L, Kircher J, Drendel AL, et al. A survey of children’s perspectives on pain management in the emergency department. J Emerg Med. 2014;47(3):268-276. (Survey)
  2. American College of Emergency Physicians. Point-of-care ultrasonography by pediatric emergency medicine physicians. Accessed April 1, 2022. (Policy statement)
  3. Scientific American. How does anesthesia work? Accessed April 1, 2022. (Magazine article)
  4. Nagdev A, Dreyfuss A, Martin D, et al. Principles of safety for ultrasound-guided single injection blocks in the emergency department. Am J Emerg Med. 2019;37(6):1160-1164. (Review)
  5. Walker BJ, Noonan KJ, Bosenberg AT. Evolving compartment syndrome not masked by a continuous peripheral nerve block: evidence-based case management. Reg Anesth Pain Med. 2012;37(4):393-397. (Case report and review)
  6. Tran AA, Lee D, Fassihi SC, et al. A systematic review of the effect of regional anesthesia on diagnosis and management of acute compartment syndrome in long bone fractures. Eur J Trauma Emerg Surg. 2020;46(6):1281-1290. (Systematic review; 6 articles)
  7. Alexander J, Manno M. Underuse of analgesia in very young pediatric patients with isolated painful injuries. Ann Emerg Med. 2003;41(5):617-622. (Retrospective; 180 patients)
  8. Frenkel O, Mansour K, Fischer JWJ. Ultrasound-guided femoral nerve block for pain control in an infant with a femur fracture due to nonaccidental trauma. Pediatr Emerg Care. 2012;28(2):183-184. (Case report)
  9. Gunter JB. Benefit and risks of local anesthetics in infants and children. Paediatr Drugs.2002;4(10):649-672. (Review)
  10. Neal JM, Barrington MJ, Fettiplace MR, et al. The third American Society of Regional Anesthesia and Pain Medicine Practice Advisory on Local Anesthetic Systemic Toxicity: executive summary 2017. Reg Anesth Pain Med. 2018;43(2):113-123. (Practice advisory) DOI: 10.1097/AAP.0000000000000720
  11. Lee GY, Yamada J, Kyololo O, et al. Pediatric clinical practice guidelines for acute procedural pain: a systematic review. Pediatrics. 2014;133(3):500-515. (Systematic review; clinical practice guideline)
  12. Committee on Hospital Care and Child Life Council. Child life services. Pediatrics. 2014;133(5):e1471-e1478. (Policy statement)
  13. Nafiu OO, Mills K, Tremper KK. Some cautionary tales about ideal body weight dosing of anesthetic medications: it is not all that ideal! Anesth Analg. 2018;127(2):586-588. (Review)
  14. Hebbes CP, Thompson JP. Pharmacokinetics of anaesthetic drugs at extremes of body weight. BJA Educ. 2018;18(12):364-370. (Review)
  15. Lexi-Drugs. Lexicomp. Accessed April 1, 2022. (Drug database)
  16. Williams DJ, Walker JD. A nomogram for calculating the maximum dose of local anaesthetic. Anaesthesia. 2014; Aug;69(8):847-853. (Nomogram)
  17. Chowdhry S, Seidenstricker L, Cooney DS, et al. Do not use epinephrine in digital blocks: myth or truth? Part II. A retrospective review of 1111 cases. Plast Reconstr Surg.2010;126(6):2031-2034. (Retrospective; 1111 cases)
  18. Denkler K. A comprehensive review of epinephrine in the finger: to do or not to do. Plast Reconstr Surg. 2001;108(1):114-124. (Systematic review)
  19. Häfner H-M, Röcken M, Breuninger H. Epinephrine-supplemented local anesthetics for ear and nose surgery: clinical use without complications in more than 10,000 surgical procedures. J Dtsch Dermatol Ges. 2005;3(3):195-199. (Retrospective; 10,201 patients)
  20. Hewson DW, Bedforth NM, Hardman JG. Peripheral nerve injury arising in anaesthesia practice. Anaesthesia. 2018;73(S1):51-60. (Review)
  21. Highland EM Ultrasound Fueled Pain Management. What needle? Accessed April 1, 2022. (FOAM)
  22. American Society of Anesthesiologists Committee on Standards and Practice Parameters. Standards for basic anesthetic monitoring. Accessed April 1, 2022. (Practice guideline)
  23. emDOCs.net - Emergency Medicine Education2019. Pain profiles - nerve block tips & tricks: sterility, safety, simulation. Accessed April 1, 2022. (FOAM)
  24. Lin M. New trick of trade: recent chats on linear U/S probe in peripheral IV placement & tegaderm damaging probe. Slide probe into folded “cuff” of sterile glove. Flat edge and no wrinkles with probe cover. Bonus: glove ? fingers out of way. (Gel goes in first) Accessed April 1, 2022. (FOAM)
  25. Disinfection of ultrasound transducers used for percutaneous procedures: intersocietal position statement. J Ultrasound Med. 2021;40(5):895-897. (Position statement)
  26. Neal JM, Brull R, Horn J-L, et al. The second American Society of Regional Anesthesia and Pain Medicine Evidence-Based Medicine Assessment of Ultrasound-Guided Regional Anesthesia: executive summary. Reg Anesth Pain Med. 2016;41(2):181-194. (Executive summary) DOI: 10.1097/AAP.0000000000000331
  27. Guay J, Suresh S, Kopp S. The use of ultrasound guidance for perioperative neuraxial and peripheral nerve blocks in children. Cochrane Database Syst Rev. 2016;2(2):CD011436. (Systematic review, meta-analysis; 20 studies) DOI: 10.1002/14651858.CD011436.pub2
  28. Lam DK, Corry GN, Tsui BC. Evidence for the use of ultrasound imaging in pediatric regional anesthesia: a systematic review. Reg Anesth Pain Med. 2016;41(2):229-241. (Review)
  29. Neal JM, Barrington MJ, Brull R, et al. The second ASRA practice advisory on neurologic complications associated with regional anesthesia and pain medicine: executive summary 2015. Reg Anesth Pain Med. 2015;40(5):401-430. (Executive summary)
  30. Dufour E, Donat N, Jaziri S, et al. Ultrasound-guided perineural circumferential median nerve block with and without prior dextrose 5% hydrodissection: a prospective randomized double-blinded noninferiority trial. Anesth Analg. 2012;115(3):728-733. (Randomized noninferiority trial; 95 patients)
  31. Dufour E, Jaziri S, Novillo MA, et al. A randomized trial to determine the minimum effective lidocaine volume for median nerve block using hydrodissection. Sci Rep.2022;12(1):52. (Randomized controlled trial; 52 patients)
  32. Herring AA, Stone MB, Frenkel O, et al. The ultrasound-guided superficial cervical plexus block for anesthesia and analgesia in emergency care settings. Am J Emerg Med.2012;30(7):1263-1267. (Case report)
  33. Kumita S, Murouchi T, Arakawa J. Ultrasound-guided maxillary and inferior alveolar nerve blocks for postoperative analgesia in gnathoplasty. Asian J Anesthesiol. 2017;55(4):89-90. (Case report)
  34. Flores S, Herring AA. Ultrasound-guided greater auricular nerve block for emergency department ear laceration and ear abscess drainage. J Emerg Med. 2016;50(4):651-655. (Case report)
  35. Mak PH, Irwin MG, Ooi CG, et al. Incidence of diaphragmatic paralysis following supraclavicular brachial plexus block and its effect on pulmonary function. Anaesthesia.2001;56(4):352-356. (Prospective; 30 patients)
  36. Selvi F, Bedel C, Akcimen M. Evaluation of vapocoolant spray effect on pain reduction during digital nerve block: a randomized clinical trial. Am J Emerg Med. 2021;50:260-263. (Prospective randomized clinical study; 150 patients)
  37. Suresh S, Ecoffey C, Bosenberg A, et al. The European Society of Regional Anaesthesia and Pain Therapy/American Society of Regional Anesthesia and Pain Medicine recommendations on local anesthetics and adjuvants dosage in pediatric regional anesthesia. Reg Anesth Pain Med. 2018;43(2):211-216. (Practice guideline)
  38. Roberts S. Peripheral nerve blocks for children. NYSORA. Accessed April 1, 2022. (Website, FOAM)
  39. Suresh SP, Polaner DM, Coté CJ. Regional anesthesia. In: Coté CJ, Lerman J, Anderson, BJ, ed. A Practice of Anesthesia for Infants and Children. 6th ed. Elsevier; 2019:941-984. (Book chapter)
  40. Marhofer P, Sitzwohl C, Greher M, et al. Ultrasound guidance for infraclavicular brachial plexus anaesthesia in children. Anaesthesia. 2004;59(7):642-646. (Randomized clinical trial; 40 children)
  41. Frenkel O, Liebmann O, Fischer JW. Ultrasound-guided forearm nerve blocks in kids: a novel method for pain control in the treatment of hand-injured pediatric patients in the emergency department. Pediatr Emerg Care. 2015;31(4):255-259. (Prospective descriptive study; 10 patients)
  42. Tezel O, Kaldirim U, Bilgic S, et al. A comparison of suprascapular nerve block and procedural sedation analgesia in shoulder dislocation reduction. Am J Emerg Med.2014;32(6):549-552. (Prospective randomized trial; 41 patients)
  43. Kriwanek KL, Wan J, Beaty JH, et al. Axillary block for analgesia during manipulation of forearm fractures in the pediatric emergency department a prospective randomized comparative trial. J Pediatr Orthop. 2006;26(6):737-740. (Randomized controlled trial; 41 patients) DOI: 10.1097/01.bpo.0000229976.24307.30
  44. Pershad J, Todd K, Waters T. Cost-effectiveness analysis of sedation and analgesia regimens during fracture manipulation in the pediatric emergency department. Pediatr Emerg Care. 2006;22(10):729-736. (Analytic model)
  45. Mori T, Nomura O, Ihara T. Ultrasound-guided peripheral forearm nerve block for digit fractures in a pediatric emergency department. Am J Emerg Med. 2019;37(3):489-493. (Case series; 6 patients)
  46. Reid N, Stella J, Ryan M, et al. Use of ultrasound to facilitate accurate femoral nerve block in the emergency department. Emerg Med Australas. 2009;21(2):124-130. (Prospective; 67 patients, 12 pediatric)
  47. Wathen JE, Gao D, Merritt G, et al. A randomized controlled trial comparing a fascia iliaca compartment nerve block to a traditional systemic analgesic for femur fractures in a pediatric emergency department. Annal Emerg Med. 2007;50(2):162-171. (Randomized controlled trial; 55 patients) DOI: 10.1016/j.annemergmed.2006.09.006
  48. Oberndorfer U, Marhofer P, Bösenberg A, et al. Ultrasonographic guidance for sciatic and femoral nerve blocks in children. Br J Anaesth. 2007;98(6):797-801. (Randomized controlled trial; 46 patients) DOI: 10.1093/bja/aem092
  49. Moake MM, Presley BC, Barnes RM. Ultrasound-guided posterior tibial nerve block for plantar foot foreign body removal. Pediatr Emerg Care. 2020;36(5):262-265. (Case report)
  50. Grossbard GD, Love BRT. Femoral nerve block: a simple and safe method of instant analgesia for femoral fractures in children. ANZ J Surg. 1979;49(5):592-594. (Retrospective)
  51. Chu RSL, Browne GJ, Cheng NG, et al. Femoral nerve block for femoral shaft fractures in a paediatric emergency department: can it be done better? Eur J Emerg Med.2003;10(4):258-263. (Retrospective; 117 patients)
  52. Turner AL, Stevenson MD, Cross KP. Impact of ultrasound-guided femoral nerve blocks in the pediatric emergency department. Pediatr Emerg Care. 2014;30(4):227-229. (Retrospective; 81 patients) DOI: 10.1097/PEC.0000000000000101
  53. Ritcey B, Pageau P, Woo MY, et al. Regional nerve blocks for hip and femoral neck fractures in the emergency department: a systematic review. CJEM. 2016;18(1):37-47. (Systematic review; 9 studies) DOI: 10.1017/cem.2015.75
  54. Black KJL, Bevan CA, Murphy NG, et al. Nerve blocks for initial pain management of femoral fractures in children. Cochrane Database Syst Rev. 2013(12):CD009587. (Systematic review; 1 randomized trial, 55 children aged between 16 months and 15 years)
  55. Heffler MA, Brant JA, Singh A, et al. Ultrasound-guided regional anesthesia of the femoral nerve in the pediatric emergency department. Pediatr Emerg Care. 2022 Jan 10. DOI: 10.1097/PEC.0000000000002607 (Comparative study; 85 cases)
  56. Neubrand TL, Roswell K, Deakyne S, et al. Fascia iliaca compartment nerve block versus systemic pain control for acute femur fractures in the pediatric emergency department. Pediatr Emerg Care. 2014;30(7):469-473. (Retrospective; 259 patients)
  57. Nan Y, Yang QQ, Li XW, et al. [Application of ultrasound guidance for fascia iliaca compartment block in pediatric femoral surgery]. Zhonghua Yi Xue Za Zhi.2017;97(4):300-302. (Prospective; 30 patients)
  58. Eastburn E, Hernandez MA, Boretsky K. Technical success of the ultrasound-guided supra-inguinal fascia iliaca compartment block in older children and adolescents for hip arthroscopy. Paediatr Anaesth. 2017;27(11):1120-1124. (Retrospective; 17 patients)
  59. Shank ES, Martyn JA, Donelan MB, et al. Ultrasound-guided regional anesthesia for pediatric burn reconstructive surgery: a prospective study. J Burn Care Res.2016;37(3):e213-e217. (Prospective randomized study; 19 patients)
  60. Kopka A, Serpell M. Distal nerve blocks of the lower limb. Cont Edu Anaesth Crit Care Pain. 2005;5(5):166-170. (Review)
  61. Herring AA, Stone MB, Fischer J, et al. Ultrasound-guided distal popliteal sciatic nerve block for ED anesthesia. Am J Emerg Med. 2011;29(6):697.e693-697.e695. (Case series; 4 patients)
  62. Cisewski DH, Alerhand S. ‘SCALD-ED’ block: superficial cutaneous anesthesia in a lateral leg distribution within the emergency department – a case series. J Emerg Med.2019;56(3):282-287. (Case series)
  63. Mori T, Hagiwara Y. Ultrasound-guided popliteal sciatic nerve block for an ankle laceration in a pediatric emergency department. Pediatr Emerg Care. 2017;33(12):803-805. (Case report)
  64. Perlas A, Niazi A, McCartney C, et al. The sensitivity of motor response to nerve stimulation and paresthesia for nerve localization as evaluated by ultrasound. Reg Anesth Pain Med. 2006;31(5):445-450. (Prospective observational trial; 102 patients)
  65. van Geffen GJ, van den Broek E, Braak GJJ, et al. A prospective randomised controlled trial of ultrasound guided versus nerve stimulation guided distal sciatic nerve block at the popliteal fossa. Anaesth Intensive Care. 2009;37(1):32-37. (Randomized controlled trial; 40 patients)
  66. Reinoso-Barbero F, Saavedra B, Segura-Grau E, et al. Anatomical comparison of sciatic nerves between adults and newborns: clinical implications for ultrasound guided block. J Anat. 2014;224(2):108-112. (Anatomy cadaver study)
  67. Schmidt AH. Acute compartment syndrome. Injury. 2017;48:S22-S25. (Review)
  68. Soares LG, Brull R, Chan VW. Teaching an old block a new trick: ultrasound-guided posterior tibial nerve block: letters to the editor. Acta Anaesthesiol Scand.2008;52(3):446-447. (Letter to the editor)
  69. Redborg KE, Antonakakis JG, Beach ML, et al. Ultrasound improves the success rate of a tibial nerve block at the ankle. Reg Anesth Pain Med. 2009;34(3):256-260. (Randomized controlled trial; 18 patients)
  70. Blanco R, Parras T, McDonnell JG, et al. Serratus plane block: a novel ultrasound-guided thoracic wall nerve block. Anaesthesia. 2013;68(11):1107-1113. (Prospective descriptive study; 4 volunteers)
  71. Paul S, Bhoi SK, Sinha TP, et al. Ultrasound-guided serratus anterior plane block for rib fracture-associated pain management in emergency department. J Emerg Trauma Shock. 2020;13(3):208-212. (Case series; 10 patients)
  72. Mahmoud S, Miraflor E, Martin D, et al. Ultrasound-guided transverse abdominis plane block for ED appendicitis pain control. Am J Emerg Med. 2019;37(4):740-743. (Case series; 3 patients)
  73. Forero M, Adhikary SD, Lopez H, et al. The erector spinae plane block: a novel analgesic technique in thoracic neuropathic pain. Reg Anesth Pain Med. 2016;41(5):621-627. (Case series; 2 patients)
  74. Durant E, Dixon B, Luftig J, et al. Ultrasound-guided serratus plane block for ED rib fracture pain control. Am J Emerg Med. 2017;35(1):197.e193-e197. (Case report)
  75. Luftig J, Mantuani D, Herring AA, et al. Successful emergency pain control for posterior rib fractures with ultrasound-guided erector spinae plane block. Am J Emerg Med.2018;36(8):1391-1396. (Case series)
  76. Abdelhamid K, ElHawary H, Turner JP. The use of the erector spinae plane block to decrease pain and opioid consumption in the emergency department: a literature review. J Emerg Med. 2020;58(4):603-609. (Comprehensive review; 10 studies)
  77. Tekin E, Ahiskalioglu A, Aydin ME, et al. High-thoracic ultrasound-guided erector spinae plane block for acute herpes zoster pain management in emergency department. Am J Emerg Med. 2019;37(2):e371-e375. (Case report)
  78. Mantuani D, Luftig J, Herring A, et al. A novel technique to reduce reliance on opioids for analgesia from acute appendicitis: the ultrasound-guided erector spinae plane block. Clin Pract Cases Emerg Med. 2019;3(3):248-251. (Case report)
  79. Chin KJ. Thoracic wall blocks: from paravertebral to retrolaminar to serratus to erector spinae and back again - a review of evidence. Best Pract Res Clin Anaesthesiol.2019;33(1):67-77. (Review)
  80. Brady-Fryer B, Wiebe N, Lander JA. Pain relief for neonatal circumcision. Cochrane Database Syst Rev. 2004;(4):CD004217. (Systematic review, meta-analysis; 14 trials)
  81. Faraoni D, Gilbeau A, Lingier P, et al. Does ultrasound guidance improve the efficacy of dorsal penile nerve block in children? Paediatr Anaesth. 2010;20(10):931-936. (Randomized controlled trial; 40 patients)
  82. Teunkens A, Van de Velde M, Vermeulen K, et al. Dorsal penile nerve block for circumcision in pediatric patients: a prospective, observer-blinded, randomized controlled clinical trial for the comparison of ultrasound-guided vs landmark technique. Paediatr Anaesth. 2018;28(8):703-709. (Prospective randomized controlled trial; 310 patients)
  83. Rose G, Costa V, Drake A, et a;. Ultrasound-guided dorsal penile nerve block performed in a case of zipper entrapment injury. J Clin Ultrasound. 2017;45(9):589-591. (Case report)
  84. Flores S, Herring AA. Ultrasound-guided dorsal penile nerve block for ED paraphimosis reduction. Am J Emerg Med. 2015;33(6):863.e3-e5. (Case report)
  85. Walker BJ, Long JB, Sathyamoorthy M, et al. Complications in pediatric regional anesthesia: an analysis of more than 100,000 blocks from the pediatric regional anesthesia network. Anesthesiology. 2018;129(4):721-732. (Prospective observation study; 104,393 blocks in 91,701 patients) DOI: 10.1097/ALN.0000000000002372
  86. Tsui BCH, Li LXY, Pillay JJ. Compressed air injection technique to standardize block injection pressures. Can J Anaesth. 2006;53(11):1098-1102. (Bench science study)
  87. Herring A. Making your own pressure monitor. Highland EM Ultrasound Fueled Pain Management. Accessed April 1, 2022. (FOAM)
  88. Auroy Y, Benhamou D, Bargues L, et al. Major complications of regional anesthesia in France: the SOS Regional Anesthesia Hotline Service. Anesthesiology. 2002;97(5):1274-1280. (Prospective observational trial; 158,083 procedures)
  89. Gauss A, Tugtekin I, Georgieff M, et al. Incidence of clinically symptomatic pneumothorax in ultrasound-guided infraclavicular and supraclavicular brachial plexus block. Anaesthesia. 2014;69(4):327-336. (Prospective observational trial; 6366 blocks)
  90. Neal JM, Mulroy MF, Weinberg GL. American Society of Regional Anesthesia and Pain Medicine checklist for managing local anesthetic systemic toxicity: 2012 version. Reg Anesth Pain Med. 2012;37(1):16-18. (Practice guideline) DOI: 10.1097/AAP.0b013e31822e0d8a
  91. Oliveira ACG, Neves ILI, Sacilotto L, et al. Is it safe for patients with cardiac channelopathies to undergo routine dental care? experience from a single-center study. J Am Heart Assoc. 2019;8(15):e012361. (Randomized controlled trial; 28 patients)
  92. Hsieh VC, Krane EJ, Morgan PG. Mitochondrial disease and anesthesia. J Inborn Errors Metab Screen. 2017;5:2326409817707770. (Review)
  93. Srivastava A, Santagostino E, Dougall A, et al. WFH guidelines for the management of hemophilia, 3rd edition. Haemophilia. 2020;26(S6):1-158. (Review)
  94. Ponde VC, Athani BD. Role of regional anaesthesia in major limb operations in children with cerebral palsy. Indian J Anaesth. 2007;51(3):220. (Case series; 62 patients)
  95. Nolan J, Chalkiadis GA, Low J, et al. Anaesthesia and pain management in cerebral palsy. Anaesthesia. 2000;55(1):32-41. (Review)
  96. Szperka CL, Gelfand AA, Hershey AD. Patterns of use of peripheral nerve blocks and trigger point injections for pediatric headache: results of a survey of the American Headache Society Pediatric and Adolescent Section. Headache. 2016;56(10):1597-1607. (Survey study, review)
  97. Shauly O, Gould DJ, Sahai-Srivastava S, et al. Greater occipital nerve block for the treatment of chronic migraine headaches: a systematic review and meta-analysis. Plast Reconstr Surg. 2019;144(4):943-952. (Systematic review, meta-analysis; 9 studies)
  98. Patel D, Yadav K, Taljaard M, et al. Effectiveness of peripheral nerve blocks for the treatment of primary headache disorders: a systematic review and meta-analysis. Ann Emerg Med. 2022;79(3):251-261. (Systematic review, meta-analysis; 9 studies)
  99. Blumenfeld A, Ashkenazi A, Napchan U, et al. Expert consensus recommendations for the performance of peripheral nerve blocks for headaches--a narrative review. Headache. 2013;53(3):437-446. (Expert consensus recommendations and review)
  100. Dubrovsky AS. Nerve blocks in pediatric and adolescent headache disorders. Curr Pain Headache Rep. 2017;21(12):50. (Review)
  101. Troy E, Yonker M. ED and inpatient management of headache in children and adolescents. Curr Neurol Neurosci Rep. 2020;20(6):15. (Review)
  102. Dubrovsky AS, Friedman D, Kocilowicz H. Pediatric post-traumatic headaches and peripheral nerve blocks of the scalp: a case series and patient satisfaction survey. Headache. 2014;54(5):878-887. (Retrospective; 28 patients, 62 blocks)
  103. Kim E, Cucchiaro G. Occipital nerve blocks for relief of headaches in patients with ventriculoperitoneal shunts: a case series. J Child Neurol. 2019;34(11):674-678. (Case series; 7 patients)
  104. Gelfand AA, Reider AC, Goadsby PJ. Outcomes of greater occipital nerve injections in pediatric patients with chronic primary headache disorders. Pediatr Neurol. 2014;50(2):135-139. (Retrospective; 46 patients)
  105. Afridi SK, Shields KG, Bhola R, et al. Greater occipital nerve injection in primary headache syndromes--prolonged effects from a single injection. Pain. 2006;122(1-2):126-129. (Retrospective; 54 patients)
  106. Palamar D. Ultrasound-guided greater occipital nerveblock: an efficient technique in chronic refractory migraine without aura? Pain Physician. 2015;18:153-162. (Randomized controlled trial; 32 patients)
  107. Naja Z, Al-Tannir M, El-Rajab M, et al. Nerve stimulator-guided occipital nerve blockade for postdural puncture headache. Pain Pract. 2009;9(1):51-58. (Randomized controlled trial; 50 patients)
  108. Pingree MJ, Sole JS, TG O'Brien, et al. Clinical efficacy of an ultrasound-guided greater occipital nerve block at the level of C2. Reg Anesth Pain Med. 2017;42(1):99-104. (Prospective; 14 blocks)
  109. Zipfel J. Ultrasound-guided intermediate site greater occipital nerve infiltration: a technical feasibility study. Pain Physician. 2016;19(7):E1027-E1034. (Retrospective; 12 patients)
  110. Uppal V, Sancheti S, Kalagara H. Transversus abdominis plane (tap) and rectus sheath blocks: a technical description and evidence review. Curr Anesthesiol Rep. 2019;9(4):479-487. (Review)
  111. Venkatraman R, Ranganathan Jothi A, Sakthivel A, et al. Efficacy of ultrasound-guided transversus abdominis plane block for postoperative analgesia in patients undergoing inguinal hernia repair. Local Reg Anesth. 2016;9:7-12. (Randomized controlled trial; 60 patients)
  112. Hernandez MC, Finnesgard EJ, Aho JM, et al. Reduced opioid prescription practices and duration of stay after TAP block for laparoscopic appendectomy. J Gastrointest Surgy.2020;24(2):418-425. (Retrospective; 960 patients, 145 received block)
  113. Hamill JK, Liley A, Hill AG. Rectus sheath block for laparoscopic appendicectomy: a randomized clinical trial: rectus sheath block for appendicectomy. ANZ J Surg.2015;85(12):951-956. (Randomized controlled trial; 130 patients)
  114. Hamill JK, Rahiri J-L, Liley A, et al. Rectus sheath and transversus abdominis plane blocks in children: a systematic review and meta-analysis of randomized trials. Pediatr Anesth. 2016;26(4):363-371. (Systematic review, meta-analysis)
  115. De Cassai A, Bonvicini D, Correale C, et al. Erector spinae plane block: a systematic qualitative review. Minerva Anestesiola. 2019;85(3):308-319. (Systematic review)
  116. Mantuani D, Josh Luftig PA, Herring A, et al. Successful emergency pain control for acute pancreatitis with ultrasound guided erector spinae plane blocks. Am J Emerg Med. 2020;38(6):1298.e1295-1298.e1297. (Case report)
  117. Herring AA. Bringing ultrasound-guided regional anesthesia to emergency medicine. AEM Educ Train. 2017;1(2):165-168. (Commentary)
  118. Sparks S, Evans D, Byars D. A low cost, high fidelity nerve block model. Crit Ultrasound J.2014;6(1):12. (Phantom description)
  119. Naraghi L, Lin J, Odashima K, et al. Ultrasound-guided regional anesthesia simulation: use of meat glue in inexpensive and realistic nerve block models. BMC Med Educ.2019;19(1):145. (Phantom description)

Want more?

Get the full article 👇

Full Ultrasound-Guided Pediatric Nerve Blocks Pathway
Full Ultrasound-Guided Pediatric Nerve Blocks Pathway
Administering Nerve Blocks to Pediatric Patients
Administering Nerve Blocks to Pediatric Patients
Nerve Block Selection Based on Injury Location
Nerve Block Selection Based on Injury Location
FacebookTwitterLinkedInInstagramYouTubePinterest

EB Medicine

FOAMed

Podcast

© EB Medicine. All rights reserved