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Incidence of Phrenic Nerve Palsy in Pediatric Costoclavicular Brachial Plexus Block

Julio La Palma1, Hipólito Labandeyra2,3, Gregory Contreras-Pérez2

  • 1Department of Anesthesia, Hospital de Niños Dr. Orlando Alassia, Santa Fe, Argentina.

Paediatric Anaesthesia
|September 8, 2025
PubMed

Insights

The costoclavicular brachial plexus block (CBPB) shows promise for pediatric upper limb surgery, with no observed phrenic nerve palsy in a recent study. This regional anesthesia technique provided effective pain relief with minimal opioid use in children.

Area of Science:

  • Anesthesiology
  • Pediatric Surgery
  • Regional Anesthesia

Background:

  • The costoclavicular brachial plexus block (CBPB) is recognized for adult upper limb surgery.
  • Limited data exists on CBPB safety and efficacy in pediatric populations.
  • Phrenic nerve palsy is a potential concern in brachial plexus blocks.

Purpose of the Study:

  • To evaluate the incidence of phrenic nerve palsy following CBPB in pediatric patients.
  • To assess the effectiveness of CBPB for postoperative analgesia in children.
  • To determine the safety profile of CBPB in pediatric regional anesthesia.

Main Methods:

  • A descriptive observational study involving 30 pediatric patients undergoing upper limb orthopedic surgery.
  • M-mode ultrasound was used to assess diaphragmatic excursion before and after the block.
  • Incidence of phrenic nerve palsy and postoperative opioid consumption were recorded.

Main Results:

  • No cases of phrenic nerve palsy were observed in the study cohort.
  • Effective postoperative analgesia was achieved with CBPB.
  • Minimal opioid consumption was noted post-procedure.

Conclusions:

  • The costoclavicular brachial plexus block appears to be a safe and effective option for pediatric regional anesthesia.
  • CBPB demonstrates a favorable safety profile regarding phrenic nerve palsy in children.
  • Further research is warranted to solidify the role of CBPB in pediatric surgical anesthesia.

Keywords:
costoclavicular brachial plexus blockpediatric anesthesiaphrenic nerve palsyregional anesthesia

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