Lower limb nerve blocks in children using unsheathed needles and a nerve stimulator

Abstract

The use of unsheathed non-insulated needles and a nerve stimulator as an aid to peripheral nerve blockade in children has received little attention in the literature. In order to assess the value of such a technique, a study was performed in children presenting for lower limb surgery with no contraindication to femoral and/or sciatic nerve block. Four hundred and eleven children, mean age 4.25 (SD 3.8) years and mean weight 16.8 (SD 9.4) kg, received a total of 883 peripheral nerve blocks: 419 femoral nerve blocks and 464 sciatic nerve blocks. One hundred and twenty six children were below one year of age. The current required to stimulate the more superficial femoral nerve ranged from 0.5-1.0 mA whilst for the deeper sciatic nerve ranged from 1.2-2.0 mA. Staff in training, with little or no experience of the technique, successfully performed 223 nerve blocks in 114 patients under the author's guidance. The overall success rate was 98%, the failures occurring early in the series.