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Brachial plexus anaesthesia in children: lateral infraclavicular vs axillary approach
E Fleischmann1, P Marhofer, M Greher
1Department of Anaesthesia and General Intensive Care Medicine, Medical School, University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
Insights
The lateral vertical infraclavicular brachial plexus (LVIBP) block offers superior sensory and motor blockade compared to the axillary brachial plexus (ABP) block in children undergoing upper-limb surgery. This study found LVIBP blocks to be safe and effective for paediatric trauma.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Regional Anesthesia
Background:
- Brachial plexus blockade is standard for upper-limb surgery.
- Axillary brachial plexus (ABP) block is typically preferred in pediatric patients due to safety concerns.
- Lateral infraclavicular brachial plexus (LVIBP) block shows promise for enhanced safety and efficacy.
Purpose of the Study:
- To prospectively evaluate and compare the analgesic efficacy of axillary brachial plexus (ABP) versus lateral vertical infraclavicular brachial plexus (LVIBP) blocks in pediatric trauma surgery.
- To assess the safety and effectiveness of LVIBP blocks in children.
Main Methods:
- A prospective randomized study involving 40 pediatric trauma patients (ages 1-10 years).
- Patients were randomized to receive either ABP or LVIBP block using 0.5% ropivacaine.
- Sensory and motor blockade were assessed using visual analogue scores, Vester-Andersen's criteria, pinprick tests, and motor function tests.
Main Results:
- 100% of patients in the LVIBP group met Vester-Andersen's criteria, compared to 80% in the ABP group (P=0.035).
- LVIBP demonstrated significantly greater effectiveness in sensory blockade for axillary (P < 0.0001), musculocutaneous (P=0.002), and medial brachial cutaneous nerves (P=0.008).
- Motor blockade was also significantly more effective with LVIBP (axillary: P < 0.0001; musculocutaneous: P=0.003). No major complications were reported.
Conclusions:
- Lateral vertical infraclavicular brachial plexus (LVIBP) blocks are safe and effective in pediatric patients.
- LVIBP blocks provide a broader spectrum of sensory and motor blockade compared to the axillary brachial plexus (ABP) approach.
- LVIBP represents a valuable alternative for brachial plexus anesthesia in pediatric upper-limb surgery.
Background:
Brachial plexus blockade is a well-established technique in upper-limb surgery. In paediatric patients, the axillary route is usually preferred to infraclavicular approaches because of safety considerations. Recent reports on a lateral infraclavicular approach offering greater safety in adults prompted us to perform a prospective randomized study to assess the analgesic efficacy of axillary vs lateral vertical infraclavicular brachial plexus (LVIBP) blocks in paediatric trauma surgery.
Methods:
Forty paediatric trauma patients (ASA physical status I and II, age range 1-10 years) scheduled for forearm or hand surgery were randomly assigned to either axillary brachial plexus (ABP group) or LVIBP group blocks using 0.5 ml.kg(-1) ropivacaine 0.5%. Sensory blockade was evaluated by a visual analogue score and Vester-Andersen's criteria, the distribution of sensory and motor blockade was evaluated by a simplified pinprick test and motor tests.
Results:
In the LVIBP group, Vester-Andersen's criteria were met by 100% of children, compared with 80% in the ABP group (P=0.035). Based on all assessable children, sensory blockade in the primary sensory regions of various nerves was significantly more effective in the LVIBP group (axillary: P < 0.0001; musculocutaneous: P=0.002; medial brachial cutaneous; P=0.008). Motor blockade was also significantly more effective (axillary: P < 0.0001; musculocutaneous: P=0.003). No major complications were observed in either group.
Discussion:
We conclude that LVIBP blocks can be safely performed in children and that they add to the spectrum of sensory and motor blockade seen with the axillary approach.