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Psoas compartment block in children: Part I--description of the technique
1International Research Center, UZ Gent, University of Gent, Gent, Belgium.
Insights
This study reports a new technique for psoas compartment blocks (PCB) in children, achieving high success rates with minimal side effects. The standardized landmarks ensure safe and effective pediatric anesthesia.
Area of Science:
- Pediatric Anesthesiology
- Regional Anesthesia Techniques
- Pain Management in Children
Background:
- Psoas compartment blocks (PCB) in pediatric patients were previously reported in small series.
- A significant incidence of epidural spread was noted as a potential side effect.
- This study introduces a series of 100 consecutive PCB using novel standardized landmarks.
Purpose of the Study:
- To evaluate the efficacy and safety of a new standardized landmark technique for psoas compartment blocks in children.
- To assess the incidence of complications, including epidural spread and vascular puncture, associated with this technique.
Main Methods:
- A series of 100 consecutive psoas compartment blocks were performed in pediatric patients (5.9-106 kg) using a nerve stimulator.
- The standardized landmark involved needle insertion in the lateral position, between the medial 2/3 and lateral 1/3 on a line from the L4 spinous process to the posterior superior iliac spine.
- Blocks were administered by residents under the supervision of a designated pediatric anesthetist.
Main Results:
- All psoas compartment blocks were clinically successful.
- 64% of blocks required a single attempt, while 26% and 10% required two or more attempts, respectively.
- Vascular puncture occurred in 16% of cases, and one patient experienced partial epidural spread without serious perioperative complications.
Conclusions:
- The new standardized landmark technique for psoas compartment blocks demonstrates a high success rate in pediatric patients.
- While epidural spread is a potential risk, this technique showed minimal relevant side effects in this series.
- Psoas compartment block remains an invasive procedure with inherent risks of serious complications.
Background:
Until recently only small series of psoas compartment blocks (PCB) in children have been reported. A high incidence of epidural spread as an important side effect was noted. A series of 100 consecutive blocks using new standardized landmarks is reported.
Methods:
In 100 consecutive children (5.9-106 kg) PCB was performed using a nerve stimulator. In the lateral position, the needle was inserted between the medial 2/3 and the lateral 1/3 on a line from the spinous process of L4 to the posterior superior iliac spine. The blocks were performed by residents in training under supervision of one specific designated pediatric anesthetist.
Results:
All blocks were clinically successful. In 64% only one attempt was necessary, in 26 patients two attempts were necessary and in 10 patients more than two attempts were necessary. In 16% a vascular puncture occurred. In one patient with a dense unilateral block a partial epidural spread occurred. No serious complications were observed during the perioperative period.
Conclusions:
The described new technique has a very high success rate with no relevant side effects. Although only one case of epidural spread occurred, PCB remains an invasive technique with the potential for serious complications.
