Pediatric Nerve Blocks

One of the neat things we brought to Guatemala was an ultrasound machine and equipment for performing nerve blocks. Regional anesthetics or selective nerve blocks have a real advantage, especially in resource-poor environments. Our opiate availability was limited and once the patients went to the floor, the nursing ratio was not as high as we'd like. As our nerve blocks can last many hours, that would help our patients get rest that first night and begin physical therapy earlier. Since nearly all our surgeries were on the extremities, for many cases we would induce anesthesia, intubate the patient, and then do the nerve block. We mostly did popliteal, saphenous, femoral, and infraclavicular blocks as single shots (we could not manage catheters) and the results were excellent. For young children, we also did caudal blocks which are similar to single shot epidurals, allowing four hours of pain relief. The surgeons were wonderfully patient in letting us do these blocks.

We had to be careful though because we didn't have our normal emergency resources. If a patient had toxicity from too much local anesthetic, we didn't have the antidote, lipid emulsion. If we punctured the lung in an infraclavicular block, we would not have X-ray or chest tubes to diagnose or treat pneumothorax. In the same way, general anesthetics carry the risk of malignant hyperthermia and we did not have dantrolene for reversal. We carried a small supply of emergency drugs and had a defibrillator, but I was concerned about these rare emergencies. On our first day, we came up with plans for most emergencies, and luckily we did not have to use them.