Abdomen
Truncal Wall Blocks
The proverbial bread and butter of pediatric regional. I imagine that the bulk of everyone’s peds regional practice is sandwiched comfortably between the rib cage and the hips. No site more clearly illustrates the need for a smorgasbord of potential blocks in my humble opinion than the belly. Whether it is multiple port sites, a new ostomy appliance in the way, or a conversion to open, having multiple blocks to pick from allows one to accommodate nearly any situation.
While these studies were not designed to evaluate changes in clinical practice over time (increased number of reporting institutions, institutional practice patterns), one might still infer some changes over time.
The most obvious difference is the explosion in the relative incidence of truncal blocks. Though only accounting for 16% of the 2012 data, the relative incidence of truncal blocks in a 6-year period nearly tripled!
Adapted from “Walker, B.J., Long, J.B., Sathyamoorthy, M., Birstler, J., Wolf, C., Bosenberg, A.T., Flack, S.H., Krane, E.J., Sethna, N.F., Suresh, S. and Taenzer, A.H., 2018. Complications in pediatric regional anesthesia: an analysis of more than 100,000 blocks from the pediatric regional anesthesia network. Anesthesiology, 129(4), pp.721-732”
Though one might not be able to draw definitive conclusions from the above PRAN data regarding the changes in clinical practice, a study out of France can corroborate the narrative.
Looking at data from a single institution over a 17-year period, one can see an explosion in the number of blocks performed. Moreover, one can see a gradual erosion in both the total number, but also the relative percentage of neuraxial blocks relative to PNB’s. The number of PNB’s performed went up a staggering 18,733%.
And this data is itself already 17-years old!
Adapted from “Rochette A, Dadure C, Raux O, Troncin R, Mailheé P, Capdevila X. A review of pediatric regional anesthesia practice during a 17-year period in a single institution. Paediatr Anaesth. 2007 Sep;17(9):874-80”
