Amiri Hamid Reza, Espandar Ramin
J Child Orthop. 2011 Feb;5(1):5-9. doi: 10.1007/s11832-010-0303-5. Epub 2010 Nov 23.
Supraclavicular brachial plexus block is considered to be one of the most effective anesthetic procedures for upper extremity surgeries. Its major drawback is placement of the needle, with inaccurate placement, especially in children, being a risk factor for pneumothorax and vascular puncture and failure of the procedure. Ultrasound-guided needle placement may reduce the risk of complications and increase the accuracy of the block, particularly in pediatric patients. Little has been published on the efficacy and safety of ultrasound-guided supraclavicular block in children based on practical experience, and there has been no published report on its usage in younger children (<6 years old).
Seventeen patients between the ages of 6 months and 6 years were randomly selected to test the efficacy of ultrasound-guided supraclavicular block in younger children. 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 surgeon's satisfaction were recorded and assessed.
The length of the procedure was 10.35 ± 1.22 min, establishment time was 89.59 + 18 s, and the duration of the 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). Not one procedure failed, and there was not one complication related to the procedure. The surgeon's satisfaction during surgery was good or excellent.
The results of this study demonstrate the efficacy and safety of the ultrasound-guided supraclavicular brachial plexus block for orthopedic upper extremity surgeries in patients less 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。其主要缺点是穿刺针的放置，放置不准确，尤其是在儿童中，是气胸、血管穿刺和手术失败的危险因素。超声引导下的穿刺针放置可降低并发症风险并提高阻滞的准确性，特别是在儿科患者中。基于实践经验，关于超声引导下锁骨上阻滞在儿童中的有效性和安全性的报道很少，且尚无关于其在幼儿（<6岁）中使用的报道。
随机选择17例年龄在6个月至6岁之间的患者，以测试超声引导下锁骨上阻滞在幼儿中的有效性。使用超声探头进行穿刺针的正确放置。使用神经定位仪确认穿刺针位置后，注入麻醉剂。记录并评估手术时间、起效时间、镇痛持续时间、与手术相关的任何并发症以及外科医生的满意度。
手术时长为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），手术时长为61.3±25.9分钟（范围15 - 110分钟）。没有一例手术失败，也没有与手术相关的并发症。手术期间外科医生的满意度为良好或优秀。
本研究结果表明，超声引导下锁骨上臂丛神经阻滞用于6岁以下患者的上肢骨科手术具有有效性和安全性。
