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Updated: Jul 15, 2026
Spinal Sonography for Ultrasound-Guided Lumbar Neuraxial Anesthesia
Published on: January 31, 2025
Ultrasonographic guidance for sciatic and femoral nerve blocks in children
U Oberndorfer1, P Marhofer, A Bösenberg
1Department of Anaesthesia and Intensive Care Medicine, Medical University Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria.
Insights
Ultrasound guidance for pediatric sciatic and femoral nerve blocks significantly prolonged sensory blockade compared to nerve stimulator guidance. This technique also reduced local anesthetic volume, improving patient outcomes in pediatric regional anesthesia.
Area of Science:
- Pediatric Anesthesiology
- Regional Anesthesia
- Medical Imaging
Background:
- Ultrasound guidance enhances regional anesthesia quality in children.
- Previous studies show benefits for upper extremity and neuraxial blocks.
Purpose of the Study:
- To compare ultrasound guidance with nerve stimulator guidance for pediatric sciatic and femoral nerve blocks.
- To determine if ultrasound guidance prolongs sensory blockade duration.
Main Methods:
- 46 children undergoing lower extremity surgery were randomized to ultrasound or nerve stimulator guidance.
- Blocks were performed using ultrasound-guided multiple injections or nerve stimulator guidance with a fixed local anesthetic dose.
- Block failure was defined by a >15% heart rate increase during surgery.
Main Results:
- Ultrasound guidance resulted in no block failures, unlike the nerve stimulator group (2 failures).
- Analgesia duration was significantly longer with ultrasound (508 min) versus nerve stimulator (335 min).
- Ultrasound guidance used smaller local anesthetic volumes for both sciatic and femoral blocks.
Conclusions:
- Ultrasound guidance for pediatric sciatic and femoral nerve blocks prolongs sensory blockade duration compared to nerve stimulator guidance.
- Smaller anesthetic volumes are effective with ultrasound guidance, enhancing safety and efficacy.
Background:
Recent studies have shown that ultrasound guidance for paediatric regional anaesthesia can improve the quality of upper extremity and neuraxial blocks. We therefore investigated whether ultrasound guidance for sciatic and femoral nerve blocks prolongs sensory blockade in comparison with nerve stimulator guidance in children.
Methods:
Forty-six children scheduled for surgery of one lower extremity were randomized to receive a sciatic and femoral nerve block under either ultrasound or nerve stimulator guidance. After induction of general anaesthesia, the blocks were performed using an ultrasound-guided multiple injection technique until the nerves were surrounded by levobupivacaine, or by nerve stimulator guidance using a predefined dose of 0.3 ml kg(-1) of levobupivacaine. An increase in heart rate of more than 15% of baseline during surgery defined a failed block. The duration of the block was determined from the injection of local anaesthetic to the time when the patient received the first postoperative analgesic.
Results:
Two blocks in the nerve stimulator group failed. There were no failures in the ultrasound group. The duration of analgesia was longer in the ultrasound group mean (sd) 508 (178) vs 335 (169) min (P < 0.05). The volume of local anaesthetic in sciatic and femoral nerve blocks was reduced with ultrasound compared with nerve stimulator guidance [0.2 (0.06) vs 0.3 ml kg(-1) (P < 0.001) and 0.15 (0.04) vs 0.3 ml kg(-1) (P < 0.001), respectively].
Conclusions:
Ultrasound guidance for sciatic and femoral nerve blocks in children increased the duration of sensory blockade in comparison with nerve stimulator guidance. Prolonged sensory blockade was achieved with smaller volumes of local anaesthetic when using ultrasound guidance.
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