Pediatric Ultrasound guided blocks “ block under vision “. Dr. Amr Abdulfatah Sayed (M.D.) Associate prof. of Anesthesia, Chronic Pain Management Ain Shams Univ. , Cairo , EGYPT Oct. 2012. Imagine . NO clicks No pops No paresthesia No trans-arterial . Under vision in real time
Dr. Amr Abdulfatah Sayed (M.D.)
Associate prof. of Anesthesia, Chronic Pain Management Ain Shams Univ. , Cairo , EGYPT
one peak to other peak is a wavelength
1) absorption.2) reflection.3) scattering.
The Ultrasound Transducer Source of Energy and Image
Energy progressively degraded (attenuate)as it enters deeper tissues
lateral & axial resolution improved with higher frequency transducers,decrease with increasing tissue depth
or honeycomb appearance
large dropout artifact.
Hokey stick 25mm
Improper body position
Proper body position
Proper operator and screen orientation
Improper operator and screen orientation
Improper hand and arm positions
Proper hand and arm position
0.25 -0.5ml /kg
0.25% bupivacaine , 1% lidocaine , 0.25% ropivacaine
front, in the sheath& behind
ColourDoppler : to identify vertebral vs &
branches of transverse cervical artery below C6
Local anesthetic injected posterior to the axillary artery resulting in a U shape spread around the artery is associated with complete blockade of the arm, forearm and hand.
Inject : MCN +12 & 6 O’clock
Inject : MCN + 10 , 2 , 6 O’clock
superficial to the Ilio-Psoas Muscle (IPM)
Base touching CFA, extending lateral to it.
Surgery on femur , knee
Dermatomes and osteotomes of the lumbosacral plexus are illustrated. (Courtesy of Mayo Foundation.)
The American Society of Regional Anesthesia and Pain Medicine. 2005
Plus femoral : whole LL block
Single for ankle & foot surgery
Dr. Amr Abdulfatah Sayed M.D.