[Ultrasound guidance in pediatric regional anesthesia]

Anatomical comparison of sciatic nerves between adults and newborns: clinical implications for ultrasound guided block

The sciatic nerve (SN) is easily blocked under ultrasound guidance by identifying either the SN common trunk or its two components: the tibial nerve (TN) and the common peroneal nerve (CPN). The authors investigate whether there are anatomical differences between newborns and adults. The SN, TN and CPN of both lower extremities in 24 (11 neonatal and 13 adults) formolized cadavers were dissected. Distances were measured from the origin of the SN (passing under the piriformis muscle) to its division into TN and CPN, and from there to the popliteal crease. The sciatic/thigh coefficient (proportion relating SN length to thigh length) and the variation coefficient for the SN were calculated. The distance from the popliteal crease to the SN division was significantly shorter in neonates than in adults (1.04 ± 0.9 cm vs. 5.6 ± 5.1 cm, P = 0.0003). In addition, the neonatal SN divided at a proportionally more distal position in the thigh than it did in adults (86 ± 13 vs. 74 ± 15%, P = 0.0059). However, the coefficient of variation between the SN-division distances was not statistically different in infants and adults (12.8 vs. 18.2%, P = 0.4345). The variations in the point of SN division seen in the adult SN are already seen in the neonatal period, but in newborns the SN divided in a more distal position in relation to the thigh than in adults, so this finding of anatomical variability in neonates suggests that ultrasound guidance can be useful when performing a SN block in these small patients.