Anaesthetic management of an infant for Achilles tendon lengthening by combined intrathecal and ultrasound guided sciatic nerve blocks

A four-month old, 4.5kg weight infant with normal mentation was posted for Achilles tendon lengthening for bilateral club foot. Anaesthesia was provided with intrathecal administration of 0.4ml of 0.5% bupivacaine and popliteal sciatic nerve block with 0.2 % bupivacaine 1.5ml to each side. The sciatic nerve was looking hypoechoic than the classical honeycomb possibly due to lesser development of connective tissue. The infant had satisfactory analgesia for 12hrs post-surgery and there was no analgesic requirement. Routine follow up for three months was uneventful. We conclude that intrathecal bupivacaine supplemented with ultrasound guided peripheral nerve blocks can be administered even in infants. As case reports like this are rare to find in literature, we report this case for its uniqueness.