Comparison of post operative analgesia supraclavicular brachial plexus block in children 5 to 10 years of age
Abstract
Background: Regional anesthesia is a recommended technique for upper limb surgeries with better postoperative profile.However paediatric regional anaesthesia for upper limb surgeries was till now difficult due to various problems like moving child ,inability to elicit parasthesia and likely injury to brachial plexeus. With the advent of nerve stimulators and ultrasound guided blocks ,we can now overcome the above problems. We evaluated the effect of ultrasound guided bupivacaine for quality and duration of post op analgesia.
Methodology: Sixty paediatric patients posted for elective and emergency upper limb surgeries were enrolled for a prospective, randomized, study. Patients were divided into two groups, the control group A and the study group B.In group A (n =30) patients were given general anaesthesia for the surgery and at the end of it, conventional analgesics were given and In group B (n = 30),after GA , 10 ml of 0.325% bupivacaine + normal saline were given ultrasound guided supraclavicular brachial plexus block. Quality and duration of post op analgesia and time to first rescue analgesia were recorded.
Results: The onset times for pain was significantly shorter in A than B group (p < 0.05). The duration of analgesia (DOA) was significantly longer in B group than A group (p < 0.0001). Heart rate levels in group B were significantly lower 15 min after block (p< 0.001). SBP and DBP levels in B group were significantly lower than in A (p < 0.001). No major adverse effects were observed in either of the groups except for sedation 8 and respiratory depression in 6 patients of group A.
Conclusion: Supraclavicular brachial plexus block significantly lengthens the onset time of pain and prolongs the duration of post op analgesia. Patients in group B had good quality analgesia with no adverse effects.
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References
2. Ecoffey C, Lacroix F, Giaufré E, Orliaguet G, Courrèges P. Epidemiology and morbidity of regional anesthesia in children: a follow‐up one‐year prospective survey of the French‐Language Society of Paediatric Anaesthesiologists (ADARPEF). Pediatric Anesthesia. 2010 Dec 1;20(12):1061-9. [PubMed]
3. Lönnqvist PA, Morton NS. Postoperative analgesia in infants and children. Br J Anaesth. 2005 Jul;95(1):59-68. Epub 2005 Jan 21. [PubMed]
4. Dadure C, Capdevila X. Continuous peripheral nerve blocks in children. Best Practice & Research Clinical Anaesthesiology. 2005 Jun 30;19(2):309-21.
5. Kapral S, Greher M, Huber G, Willschke H, Kettner S, Kdolsky R, Marhofer P. Ultrasonographic guidance improves the success rate of interscalene brachial plexus blockade. Regional anesthesia and pain medicine. 2008 Jun 30;33(3):253-8.
6. Marhofer P, Sitzwohl C, Greher M, Kapral S. Ultrasound guidance for infraclavicular brachial plexus anaesthesia in children. Anaesthesia. 2004 Jul;59(7):642-6. [PubMed]
7. Inberg P, Kassila M, Vilkki S, Tarkkila P, Neuvonen P. Anaesthesia for microvascular surgery in children. A combination of general anaesthesia and axillary plexus block. Acta Anaesthesiol Scand. 1995 May;39(4):518-22.
8. Jose Maria B, Tielens LK. Vertical infraclavicular brachial plexus block in children: a preliminary study. Pediatric Anesthesia. 2004 Nov 1;14(11):931-5.
9. Tobias JD. Brachial plexus anaesthesia in children. Paediatr Anaesth. 2001 May;11(3):265-75. [PubMed]
10. Ivani G, Mosseti V. Pediatric regional anesthesia. Minerva Anestesiol. 2009 Oct;75(10):577-83. [PubMed]
11. Cheng GL, Pan DD, Yang ZX, Fang GR, Gong XS. Digital replantation in children. Ann Plast Surg. 1985 Oct;15(4):325-31. [PubMed]
12. Eriksson E. Axillary brachial plexus anaesthesia in children with Citanest. Acta Anaesthesiol Scand Suppl. 1965;16:291-6. [PubMed]
13. Pande R, Pande M, Bhadani U, Pandey CK, Bhattacharya A. Supraclavicular brachial plexus block as a sole anaesthetic technique in children: an analysis of 200 cases. Anaesthesia. 2000 Aug 17;55(8):798-802.
14. Cramer KE, Glasson S, Mencio G, Green NE. Reduction of forearm fractures in children using axillary block anesthesia. Journal of orthopaedic trauma. 1995 Oct 1;9(5):407-10.
15. Fleischmann E, Marhofer P, Greher M, Waltl B, Sitzwohl C, Kapral S. Brachial plexus anaesthesia in children: lateral infraclavicular vs axillary approach. Pediatric Anesthesia. 2003 Feb 1;13(2):103-8.
16. De Jose Maria B, BanUS E, Navarro Egea M, Serrano S, PerellO M, Mabrok M. Ultrasound‐guided supraclavicular vs infraclavicular brachial plexus blocks in children. Pediatric Anesthesia. 2008 Sep 1;18(9):838-44.
17. Hicks CL, von Baeyer CL, Spafford PA, van Korlaar I, Goodenough B. The Faces Pain Scale–Revisedtoward a common metric in pediatric pain measurement. Pain. 2001 Aug 31;93(2):173-83.
18. van Dijk M, de Boer JB, Koot HM, Tibboel D, Passchier J, Duivenvoorden HJ. The reliability and validity of the COMFORT scale as a postoperative pain instrument in 0 to 3-year-old infants. Pain. 2000 Feb;84(2-3):367-77. [PubMed]
19. Wong DL, Baker CM. Pain in children: comparison of assessment scales. Pediatr Nurs. 1988 Jan-Feb;14(1):9-17. [PubMed]
20. Klaastad O, Sauter AR, Dodgson MS. Brachial plexus block with or without ultrasound guidance. Curr Opin Anaesthesiol. 2009 Oct;22(5):655-60. doi: 10.1097/ACO.0b013e32832eb7d3. [PubMed]
21. Rochette A, Dadure C, Raux O, Troncin R, MAILHEé PH, Capdevila X. A review of pediatric regional anesthesia practice during a 17‐year period in a single institution. Pediatric Anesthesia. 2007 Sep 1;17(9):874-80.
22. De Negri P, Ivani G, Tirri T, Del Piano AC. New local anesthetics for pediatric anesthesia. Curr Opin Anaesthesiol. 2005 Jun;18(3):289-92.
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