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Ultrasound-guided lower forearm median nerve block in open surgery for trigger thumb in 1- to 3-year-old children: A
Wei Liu1, Jianxia Liu1, Xingqin Tan2,3
1Department of Anesthesiology, Children's Hospital of Chongqing Medical University, Chongqing, China.
Insights
Ultrasound-guided median nerve blocks are more effective for pediatric trigger thumb surgery than traditional methods. This technique offers higher success rates and reduces the need for additional anesthesia in children.
Area of Science:
- Pediatric Anesthesiology
- Hand Surgery
- Ultrasound-Guided Procedures
Background:
- Trigger thumb is a prevalent pediatric hand condition often requiring surgical release.
- Median nerve blocks are standard for adult trigger thumb surgery, but their efficacy in children is less established.
- Evaluating novel anesthetic techniques for pediatric surgical procedures is crucial.
Purpose of the Study:
- To compare the effectiveness of ultrasound-guided lower forearm median nerve blockade versus landmark-based blockade in children undergoing open trigger thumb surgery.
- To determine if ultrasound guidance improves block success rates and reduces anesthetic requirements.
Main Methods:
- A prospective randomized study involving 100 children (1-3 years) with trigger thumb.
- Children received either ultrasound-guided (Group U) or landmark-based (Group T) median nerve blocks with ropivacaine.
- Primary endpoint was block success rate; secondary endpoints included additional anesthetic use and recovery time.
Main Results:
- The ultrasound-guided group (U) had a significantly lower rate of unsuccessful blocks (0%) compared to the landmark group (T) (26%).
- Group U required significantly less additional sufentanil and propofol compared to Group T.
- Ultrasound guidance demonstrated a higher success rate for median nerve blockade in this pediatric population.
Conclusions:
- Ultrasound-guided lower forearm median nerve block is a superior technique for pediatric trigger thumb surgery.
- This method provides more effective analgesia and a higher success rate than landmark-based techniques.
- Ultrasound guidance allows for reduced general and local anesthetic dosages in pediatric patients.
Background And Aim:
Trigger thumb is a common hand disability in children and is primarily treated with open surgery. A conscious median nerve block can usually meet the requirements for trigger thumb-releasing surgery in adults; however, its effectiveness in children requires further clarification. The present study aims to demonstrate whether ultrasound-guided lower forearm median nerve blockade is a viable option for children undergoing open surgery for trigger thumb.
Methods:
A prospective randomized study was designed to compare median nerve blocks guided by ultrasonography with those guided by anatomic landmarks. Following induction of general anesthesia, the children received a median nerve block performed either by ultrasound-guided block of the lower forearm (group U) or landmark-based blocking at the proximal wrist crease level (group T) with a 0.2% ropivacaine injection. The success rates were compared between groups as the primary endpoint; additional sufentanil and propofol administration, anesthesia recovery time, and other secondary endpoints were also compared.
Results:
A total of 100 children (age 1-3 years) with ASA status I who were scheduled for open surgery for trigger thumb were included in this study (n = 50 per group). Thirty-seven children in group T and 50 children in group U underwent successful blocks. The rate of unsuccessful blockade was significantly lower in group U than group T (0% and 26%, respectively), and rate of additional sufentanil and propofol administration was also lower in group U than in group T.
Conclusion:
Ultrasound-guided lower forearm median nerve block can provide more effective analgesia, a higher success rate, and lower general and local anesthetic dosages than the anatomic landmark-based blocking method in children undergoing open surgery for trigger thumb.
