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. 2010 Aug;4(4):315-9.
doi: 10.1007/s11832-010-0264-8. Epub 2010 May 13.

Upper extremity surgery in younger children under ultrasound-guided supraclavicular brachial plexus block: a case series

Hamid Reza Amiri, Ramin Espandar

Upper extremity surgery in younger children under ultrasound-guided supraclavicular brachial plexus block: a case series

Hamid Reza Amiri et al. J Child Orthop. 2010 Aug.

Abstract

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.

Keywords: Brachial plexus block; Pediatric anesthesia; Pediatric upper extremity surgery; Regional anesthesia; Supraclavicular; Ultrasound.

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Figures

Fig. 1
Fig. 1
Ultrasound view of the brachial plexus in the supraclavicular region. N brachial plexus, sub clav subclavian artery
Fig. 2
Fig. 2
Subclavian artery (art) and vein (v) in the supraclavicular region are confirmed by Doppler imaging
Fig. 3
Fig. 3
The needle is advanced toward the brachial plexus
See this image and copyright information in PMC

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