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Ultrasound guidance for infraclavicular brachial plexus anaesthesia in children

P Marhofer1, C Sitzwohl, M Greher

  • 1Department of Anaesthesia and Intensive Care Medicine, University of Vienna Medical School, A-1090, Vienna, Austria. peter.marhofer@univie.ac.at

Anaesthesia
|June 18, 2004
PubMed

Insights

Ultrasound guidance for pediatric infraclavicular brachial plexus blocks significantly improves anesthesia quality and duration compared to nerve stimulation. This method reduces pain and enhances sensory and motor block effectiveness in children.

Area of Science:

  • Anesthesiology
  • Pediatric Surgery
  • Medical Imaging

Background:

  • Regional anesthesia in children is crucial for surgical procedures.
  • Ultrasonography has shown benefits in adult regional anesthesia.
  • Its efficacy in pediatric populations, specifically for infraclavicular brachial plexus blocks, requires further investigation.

Purpose of the Study:

  • To compare ultrasound (US) visualization with nerve stimulation (NS) for infraclavicular brachial plexus blocks in children.
  • To evaluate the impact of US guidance on block quality, onset, duration, and patient comfort.

Main Methods:

  • A prospective, randomized study involving 40 children undergoing arm/forearm surgery.
  • Children received ropivacaine 0.5 ml.kg(-1) for infraclavicular brachial plexus blocks guided by either NS or US.
  • Parameters assessed included sensory block quality, distribution, motor block, and pain scores.

Main Results:

  • Ultrasound visualization was successful in all cases.
  • US group showed significantly lower pain scores during puncture (p=0.03).
  • US group demonstrated shorter sensory onset times (9 min vs. 15 min, p<0.001) and longer sensory block durations (384 min vs. 310 min, p<0.001).
  • Superior sensory and motor block scores were observed at 10 minutes post-insertion with US.

Conclusions:

  • Ultrasound-guided infraclavicular brachial plexus blocks in children offer faster onset and longer duration of sensory blockade than nerve stimulation.
  • Ultrasound eliminates the pain associated with nerve stimulation-induced muscle contractions.
  • US guidance enhances the overall quality and effectiveness of regional anesthesia in pediatric patients.

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