[Lower limb blocks in children].

Abstract

Conduction blocks have important advantage over spinal blocks for unilateral low extremity surgery in children. The complexity of innervation compared with upper limb is more apparent than real and a good understanding of fascial diffusion spaces is as essential as it is of neural pathways. Useful techniques can be classified into two groups, proximal blocks and distal blocks. Beside emergency situations, proximal blocks are usually performed under light general anaesthesia, with the aid of a neurostimulation. The most used proximal blocks are the femoral block, the sciatic nerve block and to a lesser degree the lumbar plexus direct blockade. Distal blocks can complete a non quite satisfactory proximal block, or be effected so as to obtain analgesia in a limited area (in a cooperative vigil patient). Some of these consist of several anaesthetic subcutaneous infiltrations for which no costly material nor special dexterity are required. A judicious choice among the main available techniques allows an excellent analgesia with a very low cost and almost no risks.