Supraclavicular brachial plexus block as a sole anaesthetic technique in children: an analysis of 200 cases

Abstract

SummaryClassical supraclavicular brachial plexus block was used as the sole anaesthetic technique in 200 children aged between 5 and 12 years undergoing closed reduction of arm fractures. The local anaesthetic used was lidocaine 1.5% with epinephrine. The block was graded as satisfactory if surgical manipulation could be performed without discomfort and unsatisfactory if general anaesthesia had to be given. In 182 children, the procedure was carried out under the block alone, whereas the remaining 18 patients required general anaesthesia. The mean (SD) time required for performing the block was 9.1 (3.7) min and the mean (SD) time to sensory blockade was 8.3 (2.3) min. The mean duration of analgesia was < 3.5 h. There were few complications, with no incidence of pneumothorax in any patient. The acceptability of the block by the children and the parents was 72 and 85%, respectively. The classical supraclavicular brachial plexus block was found to be acceptable, effective and with a good success rate.Keywords Anaesthetic techniques: regional; brachial plexus. Surgery: orthopaedic. Anaesthesia: paediatric. Brachial plexus block is often used to provide anaesthesia for closed reduction of fractures of the upper extremity [1]. Reports confirm that the supraclavicular approach is easy to perform [2] and provides reliable anaesthesia of the upper extremity with excellent muscular relaxation [3, 4]. However, there do not appear to be any reports of the use of classical supraclavicular block [5, 6] in children in the recent past.In our institution, which is situated in the eastern hills of Nepal, we encounter a large number of children with supracondylar fractures of the upper extremity. Most of these children sustain fractures as a result of falling from a height, usually from trees. As they are treated on a day-care basis, we designed a prospective study of the feasibility of using classical supraclavicular brachial plexus block as the sole anaesthetic technique. In this clinical study, we evaluated the acceptability, simplicity, safety and effectiveness of supraclavicular block in young children with upper extremity trauma. MethodsThis prospective study was undertaken in 200 ASA physical status I and II children aged between 5 and 12 years who were scheduled to undergo closed reduction of upper extremity fractures on a day-care basis. Approval of the hospital's ethics committee was obtained as was informed consent from each patient and his or her parents. The procedure was explained in detail to the children and their parents, who were present in the operating theatre during the insertion of the block. All blocks were performed or supervised by the authors. Patients with an open wound or with possible infection at the site of injection, those with associated multiple injuries and those requiring open procedures were not studied. The children were kept fasting for solids for 4 h and for clear liquids for 2 h and were premedicated with oral diazepam 0.2 mg.kg 21 1 h before the procedure. No other sedation was given du...

Clonidine does not improve quality of ropivacaine axillary brachial plexus block in children

“…Axillary brachial plexus block (ABPB) appears to be a safe and a useful technique for surgery of the forearm and hand in children (1).…”

Postoperative pain

“…Other studies have examined the feasibility of the different approaches to brachial plexus block. The infraclavicular (205,207) and the supraclavicular approach (204) are effective, there were no incidences of pneumothorax in these studies (275 patients). For a summary of evidence levels see Table 18.…”

“…Brachial plexus blocks provide satisfactory analgesia for hand and forearm surgery extending into the postoperative period: Grade B (202)(203)(204)(205)(206)(207).…”

The regional anesthesia for surgical correction of the malformation of upper extremities in pediatric

“…Pande et al (2000) проанализировали эф-фективность обезболивания у 200 детей в возрас-те от 5 до 12 лет с закрытым переломом плеча, которым выполняли только блокаду плечевого спле-тения надключичным доступом 1,5 % раствором лидокаина с адъювантом (адреналин). 182 челове-ка не нуждались в дополнительном обезболивании (средняя продолжительность анальгезии после закрытой репозиции составила 3,5 часа), 18 паци-ентов потребовали перехода на общую анестезию.…”

“…182 челове-ка не нуждались в дополнительном обезболивании (средняя продолжительность анальгезии после закрытой репозиции составила 3,5 часа), 18 паци-ентов потребовали перехода на общую анестезию. Серьезных осложнений отмечено не было: в 12 слу-чаях возникла непреднамеренная пункция подклю-чичной артерии (6 %), в 7 случаях -синдром Гор-нера (3,5 %) [38].…”