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Axillary brachial plexus block for perioperative analgesia in 250 children
W J Fisher1, R M Bingham, R Hall
1Great Ormond Street Hospital for Children, London, UK.
Insights
A cannula technique for axillary brachial plexus block is effective for pediatric hand surgery. This method provided adequate pain control for most children, reducing the need for additional pain medication.
Area of Science:
- Pediatric Anesthesiology
- Regional Anesthesia
- Pain Management
Background:
- Axillary brachial plexus block is utilized for pediatric congenital hand anomaly surgeries.
- A cannula technique has been employed since 1994 for this procedure.
- Data from a 4-year period on 250 procedures in 185 patients (median age 3 years) were analyzed.
Purpose of the Study:
- To evaluate the effectiveness and safety of the cannula technique for axillary brachial plexus block in children.
- To assess intraoperative and postoperative analgesic requirements in pediatric patients undergoing congenital hand anomaly surgery.
Main Methods:
- Data collection on 250 procedures involving a cannula technique for axillary brachial plexus block.
- Analysis of intraoperative and postoperative analgesic needs.
- Identification of block failure based on supplemental intravenous opioid use.
Main Results:
- Fifteen patients (6%) required supplemental intraoperative opioids, indicating block failure.
- Ninety-five patients (38%) needed postoperative codeine phosphate, with a mean administration time of 9 hours.
- Postoperative pain was managed with oral analgesia in most cases; only six patients received parenteral codeine.
Conclusions:
- The cannula technique for axillary brachial plexus block is proposed as an effective and safe method for pediatric patients.
- This technique demonstrates a low failure rate and facilitates effective pain management, primarily with oral analgesics.
Abstract:
A cannula technique for axillary brachial plexus block in combination with general anaesthesia has been in use since 1994 for children undergoing surgical correction of congenital hand anomalies. During a 4-year period data were collected on 250 procedures in 185 patients of median age 3 years detailing the block technique and the intraoperative and postoperative analgesic requirements. Fifteen patients (6%) required supplemental intravenous opioid intraoperatively and this is taken as a marker of failure of the block. Ninety-five patients (38%) required postoperative codeine phosphate with a mean time to receiving codeine phosphate of 9 h. Postoperative pain was controlled in this series with oral analgesia in all but six patients who received parenteral codeine. It is proposed that a cannula technique is an effective and safe method of producing axillary brachial plexus block in children.