Paediatric Pain, Blocks for Fractures and Amputations

Description

In this educational VTT session led by Caroline Wilson, the focus is on regional nerve blocks specific for fracture treatment and amputation procedures in pediatric patients. She begins by introducing common blocks such as the femoral nerve block and fascia iliaca for the lower limb, moving on to the popliteal nerve block for surgeries around the ankle and tibia. For upper limb procedures, she discusses the auxiliary nerve block for the elbow and shoulder. Caroline highlights techniques for performing these blocks using ultrasound guidance, emphasizing the importance of visualization and safety during the procedure.



Dosing guidelines are provided, particularly for the femoral nerve block, where smaller volumes (0.2 mL/kg) can effectively target multiple nerve sites. Caroline discusses the rationality behind using special peripheral nerve block needles that enhance ultrasound clarity. She talks about anatomical landmarks for achieving accurate nerve blocks, incorporating visual aids and anatomical variation considerations to enhance learner comprehension.



Caroline then touches on the use of local anesthetics, stating that ropivacaine is the safest choice due to its minimal motor block effects, followed by usage recommendations for children. The importance of having intralipid available for local anesthetic toxicity emergencies is underscored. Additionally, she introduces adjuncts for pain management such as clonidine and dexamethasone, explaining their roles despite regulatory limitations on use in nerve blocks. She wraps up by discussing the perioperative management of limb fractures, emphasizing an evidence-based approach for pain relief in pediatric patients including the use of multimodal analgesics and careful monitoring protocols to foster recovery and manage complications.



Overall, Caroline Wilson’s presentation provides a comprehensive overview of practical techniques and considerations for effective pain management in pediatric patients undergoing limb surgeries, advocating for well-established clinical practices to enhance patient outcomes.

DOI: 10.1302/3114-230288

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