Effect of Ultrasound Guided Supraclavicular Brachial Plexus Block on Intraoperative Opioid Consumption and Quality of Postoperative Analgesia in Closed Reduction and Pinning of Paediatric Supracondylar Fracture of Humerus

Abstract

Background: Supracondylar fracture of the humerus is one of the commonly encountered injuries in paediatric age group accounting for 16% of all paediatric fractures and 60% of all paediatric elbow fractures, classically occurring as a result of fall on an outstretched hand. Regional anesthesia may represent one of the best solutions for intraoperative and postoperative paediatric pain management however, due to lack of proficiency and the increased risk of complications in children and difficulty in obtaining cooperation compared to adults, it is not the method of choice for most of the anesthesiologists in children.
 Methods: A total of 50 paediatric patients were included who were to undergo CRPP and divided into two groups Group I- General anaesthesia alone (n = 25), Group II- General anaesthesia with USG guided supraclavicular brachial plexus block studied for the intraoperative opioid consumption as well as postoperative analgesia quality, duration and Opioid consumption.
 Results: Demographic data were similar in both groups (I and II). Time to first dose of analgesia after surgery in the group I was 54.8±5.4 min and 746.6±40.2 min (p<0.001). The incidence of PONV was 24% (group I) and 16% (GroupII). Duration of analgesia was significantly higher (746.6±40.2 min) and mean pain scores lower in first 24 hour. The fentanyl consumption was higher intraoperatively and rescue analgesic doses were more in group I.
 Conclusion: USG guided brachial plexus block is an excellent and effective means for analgesia in CRPP for supracondylar fracture with lower intraoperative Opioid consumption and better postoperative analgesia , lower pain scores and Opioid consumption in first 24 hour post operative period.

Supraclavicular block evaluation in oncoorthopedic patients under general anesthesia using perfusion index: A prospective cohort study

“…When used in conjunction with general anesthesia, SCBPB may be employed even in uncooperative and paediatric patients and gives enhanced post-operative pain relief. [ 1 ] Vasodilatation produced due to block-induced sympatholysis may potentially increase surgical bleed in the limb being operated. The duration of analgesia provided by brachial plexus block spans 5–7 h, while an oncosurgery generally lasts 4–5 h. Hence, if the window period after surgery but before reversal of anesthesia is employed for administering SCBPB, it bestows the triple advantage of being painless, not augmenting surgical bleed and providing longer duration of post-operative analgesia for the patient.…”

“…A fourth advantage is reduced opioid-related side effects due to opioid-sparing effect of nerve blocks given for post-operative pain relief. [ 1 2 ]…”