Ultrasound imaging for regional anesthesia in infants, children, and adolescents: a review of current literature and its application in the practice of neuraxial blocks

Abstract

Complementary to a previous publication related to pediatric extremity and trunk blockade, the authors present a comprehensive narrative review of the literature pertaining to techniques described and outcomes evaluated for ultrasound imaging in pediatric neuraxial anesthesia. The sonoanatomy related to each block is also described and illustrated to serve as a foundation for better understanding the block techniques described. For neuraxial blockade, ultrasound may fairly reliably predict the depth to loss of resistance and can enable a dynamic view of the needle and catheter after entry into the spinal canal. Particularly, in young infants, direct visualization of the needle and catheter tip may be possible, whereas in older children surrogate markers including the displacement of dura mater by the injection of fluid may be necessary for confirming needle and catheter placement. More outcome-based, prospective, randomized, controlled trials are required to prove the benefits of ultrasound when compared with conventional methods.