Related Experiment Videos
The efficacy of pre- versus postsurgical axillary block on postoperative pain in paediatric patients
F Altintas1, P Bozkurt, N Ipek
1Department of Anaesthesiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.
Insights
Pre-surgical axillary block in children for hand surgery did not prove superior for pain relief but allowed lower anesthetic concentrations. Postsurgical block resulted in fewer children needing additional analgesics within 24 hours.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Pain Management
Background:
- Axillary block is used for upper extremity surgery analgesia.
- Preemptive analgesia aims to reduce postoperative pain.
- Effectiveness of pre- vs. postsurgical axillary block in pediatric hand surgery requires further investigation.
Purpose of the Study:
- To compare the efficacy of pre- and postsurgical axillary block in managing postoperative pain in children undergoing hand and forearm surgery.
- To evaluate the impact of block timing on analgesic requirements and pain scores.
Main Methods:
- A double-blind, randomized study involving 55 children (aged 1-11 years, ASA I/II).
- Participants received either pre- or postsurgical axillary block with 0.25% bupivacaine (2 mg/kg) under general anesthesia.
- Pain was assessed using the Faces Pain Scale (FPS) and analgesic consumption over 24 hours.
Main Results:
- Postsurgical axillary block led to significantly fewer children requiring additional analgesics (83.3% vs. 32% in presurgical group, P<0.05).
- Pain onset and initial postoperative pain scores (first 8 hours) were similar between groups.
- Cumulative FPS scores were higher in the presurgical group at 10 hours post-surgery (P<0.05).
- Lower isoflurane concentrations were used in the presurgical group (0.68% vs. 1.72%, P<0.001).
Conclusions:
- While presurgical axillary block did not demonstrate superiority in pain reduction, it enabled the use of lower concentrations of inhalational anesthetics.
- Postsurgical axillary block was associated with a greater proportion of children remaining pain-free for 24 hours.
- Both pre- and postsurgical axillary blocks provided effective overall analgesia in pediatric hand and forearm surgery.
Abstract:
We compared the effects of pre- and postsurgical axillary block on pain after hand and forearm surgery in 55 children in a double-blind randomized study. The successful blocks are reported here (n=49). Children aged 1-11 years and ASA I or II were allocated randomly to receive axillary block with 2 mg.kg-1 of 0.25% bupivacaine, either after induction but before the surgery (presurgical group, n=25) or immediately after surgery, before the end of anaesthesia (postsurgical, n=24). In all patients, a standard general anaesthesia technique was used. The Faces Pain Scale (FPS) and analgesic requirements were recorded for 24 h at various times after operation. Eight patients (32%) in the presurgical group and 20 patients (83.33%) in the postsurgical group did not require additional analgesic within the first 24 h after operation (P< 0.05). In patients who had pain during the observation period, the pain started 13.66+/-2.61 h in the presurgical group and 13.14+/-2.34 h in the postsurgical group after performing block (P> 0.05). The FPS scores were similar in both groups during the first 8 h in the postoperative period (P> 0.05). There was a significant difference at 10 h after surgery (P< 0.05). Cumulative FPS score was higher in the presurgical group (10.50+/-1.06) than in the postsurgical group (9.45+/-1.28) (P< 0.05), but both groups had effective analgesia overall, the mean FPS score being less than 2. Additional analgesic consumption was similar in these patients in both groups. A lower isoflurane concentration was used in the presurgical group (0.68% vs 1.72%, P< 0.001). We did not demonstrate the superiority of preemptive analgesia, but our results indicate that presurgical axillary block with 0.25% bupivacaine allows the use of inhalational anaesthetics at lower concentrations while providing a reasonably painless postoperative period.