Local anesthetic toxicity following erector spinae plane block in a neonate: A case report.

A 6-day-old, 4.0 kg neonate presented with intestinal malrotation, necessitating laparotomy. Intra-operatively, an ultrasound-guided erector spinae plane block was performed under general anesthesia with administration of 1 mg/kg levobupivacaine. Minutes following this, acute cardiac compromise was evident from a tapering end-tidal carbon dioxide, falling oxygen saturations, and low blood pressure. Intravenous epinephrine 1 mcg/kg was administered, with some hemodynamic improvement. Intralipid (1.5 ml/kg) was given, with a return to normal hemodynamic parameters. This is the first case report of suspected local anesthetic toxicity in a neonate following an erector spinae plane block.

Successful use of ultrasound-guided caudal catheter in a child with a very low termination of dural sac and Opitz-GBBB syndrome: a case report.

We report a 2-year-old patient with Opitz-GBBB syndrome scheduled for a posterior sagittal anorectoplasty (PSARP). The ultrasound scan revealed the inferior end of dural sac just below sacrococcygeal membrane, although the patient had previously two successful caudal epidural blocks. Consequently, the epidural catheter was inserted under a real-time ultrasound guidance without dural puncture. Our patient had excellent pain relief without any side effects.

Infraclavicular brachial plexus block for the management of inadvertent intraarterial drug administration after arterial insertion of a venous cannula during ultrasound-guided venous cannulation.

This case report documents the inadvertent placement of an arterial cannula despite using realtime ultrasound to insert a peripheral venous cannula in a child with difficult venous access. The resultant limb ischemia was treated with an infraclavicular ultrasound-guided brachial plexus block as sympatholytic treatment.

Dorsal penile nerve block for male pediatric circumcision--randomized comparison of ultrasound-guided vs anatomical landmark technique.

BACKGROUND: Dorsal penile nerve block (DPNB) is a commonly performed regional anesthetic technique for male circumcision. Traditionally, DPNB is based on an anatomical landmark technique. Recently, an ultrasound-guided technique for DPNB has been described. OBJECTIVES: The aim of our study was to compare the anatomical landmark technique with this ultrasound-guided technique. The hypothesis to be tested was that ultrasound guidance of DPNB would lead to less administration of opioid when compared to the anatomical landmark technique. METHODS: Boys of ASA status I/II scheduled for day case circumcision were prospectively recruited and randomized. DPNB was performed under general anesthesia using the anatomical landmark technique or ultrasound guidance. Fentanyl was administered intraoperatively and immediately postoperatively if patients demonstrated signs of pain. Similarly, oral codeine was given prior to discharge if required. The primary outcome measure was the number of patients requiring fentanyl. Secondary outcome measures included initial pain score on emergence from general anesthesia, requirement for codeine predischarge, and time to perform block. RESULTS: A total of 32 patients were recruited to the landmark group and 34 to the ultrasound group. There was no significant difference between the two groups in terms of fentanyl administration. The ultrasound technique took longer to perform but was associated with a reduction in codeine requirement prior to discharge. CONCLUSIONS: This study does not support the routine use of ultrasound for the performance of DPNB in male pediatric circumcision. Nonetheless, an associated reduction in codeine administration postoperatively suggests some benefit in terms of postoperative pain.