Brachial plexus block with ultrasound guidance for upper-limb trauma surgery in children: a retrospective cohort study of 565 cases

Abstract

Background: Upper-limb trauma is a common indication for surgery in children, and general anaesthesia remains the method of choice for these procedures, even though suitable techniques of brachial plexus block are available and fast provision of regional anaesthesia offers a number of distinct advantages. Methods: A retrospective analysis was performed of the data of a large cohort of children undergoing ultrasound-guided brachial plexus blocks during a 4-yr period at a major trauma centre with a catchment area of 3.5 million. A total of 565 cases were sourced from two independently operating patient documentation systems. Patient data were stratified into age groups with block success as the primary outcome parameter. The influence of age on the incidence of block failure was assessed with logistic regression. Results: The block failure rate was 5.1%, starting at 1.2% in the youngest (0e3 yr), then continuously increasing up to 12.5% in the oldest (15e18 yr) but also smallest group. Age emerged as an independent predictor of block failure with an odds ratio of 1.115 and a 95% confidence interval of 1.014e1.226 (P¼0.025). No complications were observed. Conclusions: In a cohort of children receiving real-world care, with regional blocks performed by a range of anaesthetists with different skill levels, a success rate of 94.9% for upper-limb blocks in children under various levels of sedation was observed. Upper-limb blocks can be performed with high probability of success and an excellent margin of safety; this particularly applies to small children. Clinical trial registration: NCT03842423.

Asleep or awake: is paediatric regional anaesthesia without general anaesthesia possible?

“…This gave rise to an accompanying editorial 12 that questioned the wisdom of adopting this practice by the general anaesthetist without the special skills that the Viennese group possesses. Although the target group of patients is different in the study by Zapradil and colleagues, 8 the same issue is still relevant. Thus, before adopting this approach one should predefine how much supplementation with other drugs is acceptable and when, for the sake of safety, one should convert to proper general anaesthesia.…”

“…Support for this has recently been presented in the Europewide APRICOT study that showed that paediatric regional anaesthesia is still not as widespread as it deserves to be across Europe. 10 Premedication or light sedation vs deep sedation for regional block placement Zadrazil and colleagues 8 strictly labelled blocks that only needed one supplemental dose of i.v. fentanyl as block failures.…”

“…In summary, Zadrazil and colleagues 8 should be congratulated on reporting their experience with performing regional anaesthesia in awake or lightly sedated children of all ages. This may well become the preferred way forward in selected groups of paediatric patients, but use of ultrasound guidance must be viewed as obligatory.…”

“…In this issue of the British Journal of Anaesthesia, Zadrazil and colleagues 8 report their experience of 565 cases collected over 4 yr from their hospital database that shows proof of concept that paediatric regional anaesthesia, in this case upper extremity blocks, can be performed even without general anaesthesia or deep sedation.…”

Evaluation of Prediction Effect of Perfusion Index for Supraclavicular Brachial Plexus Block in Children

“…Fully effective anesthesia and analgesia are an important part of fracture treatment. Brachial plexus block (BCB) has a long history of being used for anesthesia and postoperative analgesia in upper limb surgery [4,5]. There are four frequently used approaches for brachial plexus block: intermuscular groove approach, supraclavicular approach, subclavian approach and axillary approach [6,7].…”