This is the first study where an ED(99) volume of local anaesthetic for sciatic nerve block has been evaluated. The resulting local anaesthetic volume of 0.10 ml mm(-2) cross-sectional nerve area seems to have no impact on sensory onset time, whereas the duration of sensory block is shorter.

The authors encourage physicians, health care providers, and emergency rescuers to learn this easy, noninvasive, and inexpensive technique for its effects in decreasing anxiety and pain during emergency transportation.

Background. Caudal anaesthesia is a common procedure for infants and children undergoing subumbilical surgery, mostly performed in conjunction with general anaesthesia. Even if complications are rare, the risk of postoperative apnoea is significant, especially in infants born preterm or operated upon before 46 weeks of post-conceptual age. Caudal block in sedated, spontaneously breathing patients might be a safe alternative.Methods. We investigated 512 infants and children. Premedication consisted of midazolam, sedation was induced with i.v. nalbuphine 0.1 mg kg 21 and propofol 1 mg kg 21 , and maintained with propofol 5 mg kg 21 h 21 in children, if necessary. Caudal block was performed with ropivacaine 1 ml kg 21 (0.2% or 0.35%).Results. Data were obtained from 228 infants and 284 children. Median (IQR) age was 1.3 (0.2, 3.4) yr; median body weight was 10.0 (4.8, 15.3) kg. Two hundred and thirty-three (45.51%) were born preterm and 47 (9.18%) were operated upon before 46 weeks of post-conceptual age. Caudal block was successful in 98.05% and adverse events occurred in 7.03% patients. The incidence of adverse events was not higher in born preterm or operated upon before 46 weeks of post-conceptual age than in term born infants (P¼0.35 and 0.35, respectively), or in infants vs children (P¼0.61). There was no correlation between the incidence of adverse events and continuous sedation (P¼0.07), coexisting diseases (P¼0.11), or ASA classification (P¼0.33).Conclusions. Caudal anaesthesia under sedation is associated with high success rates and a low incidence of adverse events, but requires careful and anticipatory perioperative management.