Amiri Hamid Reza, Espandar Ramin
J Child Orthop. 2010 Aug;4(4):315-9. doi: 10.1007/s11832-010-0264-8. Epub 2010 May 13.
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).
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.
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.
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.
锁骨上臂丛神经阻滞被认为是上肢手术最有效的麻醉方法之一。其主要缺点，尤其是在儿童中，是存在气胸、血管穿刺风险以及因穿刺针放置不准确导致操作失败的风险。超声引导下穿刺针放置可降低并发症风险并提高阻滞的准确性，尤其是在儿科患者中。关于超声引导下锁骨上阻滞在儿童中的有效性和安全性，公开的经验较少，据我们所知，似乎没有关于其在幼儿（6岁以下）中使用的公开报告。
为评估超声在幼儿中的有效性，随机选取了17例年龄在6个月至6岁之间的患者。使用超声探头进行穿刺针的正确放置。在使用神经定位仪确认穿刺针位置后，注入麻醉剂。记录并分析操作时间、起效时间、镇痛持续时间、与操作相关的任何并发症以及外科医生的满意度。
操作时间为10.35±1.22分钟，起效时间为89.59±18秒，镇痛持续时间为6至16小时（平均9.76±2.57小时）。恢复时间为24.4±6.5分钟（范围15 - 37分钟），手术持续时间为61.3±25.9分钟（范围15 - 110分钟）。操作无失败情况。此外，无与操作相关的并发症，手术期间外科医生的满意度良好或优秀。
本研究证明了超声引导下锁骨上臂丛神经阻滞用于6岁以下患者上肢骨科手术的有效性和安全性。
