fascia iliaca block for neonates
TRANSCRIPT
Cork University Hospital ,Ireland.
Fascia Iliaca block for a Neonate.
Quadriceps muscle biopsy from thigh of 18 day old child.
Hypotonia – Upper limb muscles more than lower limb muscles.
Undescended Testis.
Poor sucking reflex.
O/E: A 3kg full term infant with hypotonia , breathing on 0.5 l of oxygen saturating up to 98 %, with clear chest and no added heart sounds. Decreased DTR.
Investigations: Full blood count, urea and electrolytes ,Liver function test, TORCH Screen , Creatinine kinase, chest x-Ray and Electrocardiogram - Normal
Nerve Conduction Velocity – Severe motor and sensory polyneuropathy.
Electromyogram – Necrotic Myopathy.
Karyotyping - Normal male XY.
MRI - Normal
Fischer prader villi and SMA screening - Negative.
Metabolic Profile - Normal
FASCIA ILIACA BLOCK.
Aseptic technique, Supine position
24G Braun Stimuplex (25mm length)
Levobupivacaine 0.125% 4mLs.
First described in 1989 by Dalen et al.
Patient is placed in supine position
The anterior superior iliac spine and pubic tubercle are marked
Medial two third and lateral one third of the line joining these two landmarks is the injection point.
Two pop Technique.
1.Stoelting RK, (2008) In :Stoelting's Anaesthesia and Coexisting Disease. Hines & Marschall (Editors), 5th Edition, Elsevier Health Sciences
2.Ion T, Cook-Sather SD, Finkel RS, Cucchiaro G. (2005) Fascia Iliaca block for an infant with arthrogryposis multiplex congenita undergoing muscle biopsy Anesth Analg 100;82-84
DISCUSSION
Hypotonia in the newborn presents the anaesthetist with a clinical dilemma. The differential diagnosis includes muscular dystrophy, spinal muscular atrophy, myasthenia gravis, congenital myopathy, several metabolic causes and neuropathy. Affected neonates require a muscle biopsy to aid diagnosis and, because of the possible risk of prolonged muscle weakness and malignant hyperthermia in these infants, we describe an underutilized peripheral regional anaesthesia technique to obtain a satisfactory muscle biopsy without risking the complications of general anaesthesia.