Cork University Hospital ,Ireland.
Fascia Iliaca block for a Neonate.
Quadriceps muscle biopsy from thigh of 18
day old child. Hypotonia in the newborn
First described in 1989 by Dalen et al.
presents the anaesthetist with a
Hypotonia – Upper limb muscles more clinical dilemma. The differential
Patient is placed in supine position
than lower limb muscles. diagnosis includes muscular
The anterior superior iliac spine and pubic tubercle are dystrophy, spinal muscular
Undescended Testis. atrophy, myasthenia gravis,
congenital myopathy, several
Poor sucking reflex. metabolic causes and
Medial two third and lateral one third of the line joining
these two landmarks is the injection point. neuropathy. Affected neonates
O/E: A 3kg full term infant with hypotonia , require a muscle biopsy to aid
breathing on 0.5 l of oxygen saturating up to diagnosis and, because of the
Two pop Technique.
98 %, with clear chest and no added heart possible risk of prolonged muscle
sounds. weakness and malignant
Decreased DTR. hyperthermia in these infants, we
describe an underutilized
Investigations: Full blood count, urea and peripheral regional anaesthesia
electrolytes ,Liver function test, TORCH technique to obtain a satisfactory
Screen , Creatinine kinase, chest x-Ray and muscle biopsy without risking the
Electrocardiogram - Normal complications of general
Nerve Conduction Velocity – Severe motor
and sensory polyneuropathy.
Electromyogram – Necrotic Myopathy.
1.Stoelting RK, (2008)
Karyotyping - Normal male XY.
MRI - Normal
Hines & Marschall
Fischer prader villi and SMA screening -
(Editors), 5th Edition,
Metabolic Profile - Normal
2.Ion T, Cook-Sather SD,
FASCIA ILIACA BLOCK. Finkel RS, Cucchiaro G.
(2005) Fascia Iliaca
Aseptic technique, Supine position block for an infant with
24G Braun Stimuplex (25mm length) congenita undergoing
muscle biopsy Anesth
Levobupivacaine 0.125% 4mLs. Analg 100;82-84