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Upper extremity surgery in younger children under ultrasound-guided supraclavicular brachial plexus block: a case
Insights
Ultrasound-guided supraclavicular brachial plexus block is safe and effective for pediatric upper extremity surgery. This technique minimizes risks like pneumothorax and improves accuracy in children under six.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Regional Anesthesia
Background:
- Supraclavicular brachial plexus block is a primary anesthetic for upper extremity procedures.
- Risks in children include pneumothorax, vascular puncture, and inaccurate needle placement.
- Ultrasound guidance may enhance block accuracy and reduce complications in pediatric patients.
Purpose of the Study:
- To evaluate the efficacy and safety of ultrasound-guided supraclavicular brachial plexus block in children under six years of age.
- To address the limited published data on this technique in younger pediatric populations.
Main Methods:
- Seventeen pediatric patients (6 months to 6 years) were enrolled.
- Ultrasound was used for precise needle guidance.
- Anesthesia was administered after needle localization with a nerve locator.
Main Results:
- Procedure and establishment times were recorded (10.35 ± 1.22 min and 89.59 ± 18 s, respectively).
- Analgesia duration averaged 9.76 ± 2.57 hours.
- No procedure failures or complications occurred; surgeon satisfaction was high.
Conclusions:
- Ultrasound-guided supraclavicular brachial plexus block is effective and safe for pediatric orthopedic upper extremity surgeries.
- This technique is suitable for patients younger than six years.
Purpose:
Supraclavicular brachial plexus block is considered as one of the most effective anesthetic methods for upper extremity surgeries. Its major drawback, especially in children, is the risk of pneumothorax, vascular puncture, and failure of the procedure due to inaccurate placement of the needle. Ultrasound-guided needle placement may reduce the risk of complications and increase the accuracy of block, particularly in pediatric patients. There are few published experiences about the efficacy and safety of ultrasound-guided supraclavicular block in children and to our knowledge, it seems that there is no published report about its usage in younger children (less than 6 years of age).
Methods:
In order to consider the efficacy of ultrasound in younger children, 17 patients aged between 6 months and 6 years were randomly selected. The ultrasound probe was used for proper placement of the needle. After confirmation of the needle location using a nerve locator, the anesthetic agent was injected. The procedure time, establishment time, duration of analgesia, any complications related to the procedure, and the surgeon's satisfaction were recorded and analyzed.
Results:
The procedure time was 10.35 ± 1.22 min, the establishment time was 89.59 ± 18 s, and the duration of analgesia was between 6 and 16 h (mean 9.76 ± 2.57 h). The recovery time was 24.4 ± 6.5 min (range 15-37 min) and the duration of surgeries was 61.3 ± 25.9 min (range 15-110 min). There was no failure of the procedure. Also, there were no complications related to the procedure and the surgeon's satisfaction during surgery was good or excellent.
Conclusions:
This study demonstrates the efficacy and safety of the ultrasound-guided supraclavicular brachial plexus block for orthopedic upper extremity surgeries in patients younger than 6 years of age.
