The costoclavicular brachial plexus block (CCBPB) is a recently described ultrasound-guided block [1] that targets the chords of the brachial plexus in the costoclavicular space (CCS), where they are arranged superficially in a bundle. Experience in children is limited to case reports [2], hence data about safety and applications are lacking. Our goals were to determine the complication rate and identify the clinical applications of CCBPB in children.This is a single-center retrospective study conducted in a paediatric hospital in Portugal. We analysed a three-year period (January 2017 to December 2019) with data extracted from a regional anaesthesia database in which patients cannot be identified. Therefore, according to institution protocol, IRB approval was not required. Data are expressed as means (standard deviation; range) for numeric variables and as counts and percentages for categorical variables. Binomial distribution was used to estimate the 95% confidence interval (CI) for complications.Overall, 484 upper limb blocks were performed, of which the majority were CCBPB (n = 200; 41.3%). All blocks were placed under general anaesthesia. Table 1 shows the type of block performed detailed by year. A clear change in practice is noted throughout the years and, in 2019, CCBPB was preferred in 67.9% of cases.A total of 200 CCBPB were performed in 198 patients. The mean age was 9.07 ± 4.09 years. Weight ranged from 11 to 97 kg and most patients (73.23%) were classified as ASA I. Overall, 98% of CCBPB were unilateral and single shot blocks. Four catheters were placed and were infused for a mean of 2.5 days, with no malfunctions reported. See
The costoclavicular approach to the brachial plexus block has been recently described as a technique for anesthesia or postoperative analgesia of distal upper limb. In this article, we describe a case in which a continuous costoclavicular brachial plexus block was performed in a pediatric patient for conservative treatment of a traumatic radial fracture with severe elbow rigidity. Perineural catheter placement is a valuable option for pain control and functional prognosis during rehabilitation.
IntroductionOpioids are used intrathecally to manage surgical pain. There are few reports of hypothermia after spinal morphine injection, none in the pediatric population. We present a teenager’s case of mild hypothermia.Case PresentationA 15-year-old boy was scheduled for elective abdominal laparotomy. General anesthesia was combined with spinal anesthesia, using levobupivacaine and morphine. In the recovery room, he presented a decreased tympanic temperature (34.4°C) associated with excessive sweating, hyperglycemia, and complained of feeling hot. All other vital signs were normal. It was decided to maintain clinical vigilance and hourly monitoring of temperature and glycaemia values. Despite active warming, he remained hypothermic for 16 hours, with gradual remission of symptoms and normalization of glycemic values. It is unknown how intrathecal morphine causes hypothermia. The most viable hypothesis is its effect on the hypothalamus. In our case the most probable causes of post anesthesia hypothermia were excluded; therefore, we can admit that the cause of hypothermia was the spinal administration of morphine. Some reports used naloxone and lorazepam successfully. In our report, they disappeared spontaneously 16 hours later, which corroborates our diagnosis.ConclusionsChildren undergoing subarachnoid block with with intrathecal morphine may develop a disruption on thermoregulation, leading to a resistant postoperative hypothermia associated with excessive sweating.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.