Ponde Vrushali C, Puri Kriti J, Desai Ankit P, Gursale Anuya A, Zehra Serpil U O, Johari Ashok N
Department of Anaesthesiology, Surya Children Hospital, Mumbai, India.
Department of Anaesthesiology, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India.
J Anaesthesiol Clin Pharmacol. 2023 Apr-Jun;39(2):181-188. doi: 10.4103/joacp.joacp_235_21. Epub 2022 Feb 10.
The most effective approach for infraclavicular brachial plexus block in adults is to target the posterior cord, usually situated posterior to axillary artery. However, we do not know if this can be extrapolated in children. Our primary objective was to compare the clinical success rate of ultrasound guided infraclavicular brachial plexus block in children with local anesthetic injection aimed at two targets. These were posterior to axillary artery (posterior cord) and lateral to axillary artery (lateral cord). The secondary objectives involved need for intraoperative rescue analgesia, evaluation of duration of analgesia, incidence of complications such as pneumothorax and arterial puncture, comparison of postoperative pain scores and fluoroscopic dye spread pattern was also observed.
It was a randomized, prospective pilot study. Forty children undergoing forearm and hand surgeries were randomized to two groups, in accordance with the target site of the block. Target sites of Group P (20 patients) and Group L (20 patients) were posterior and lateral to the axillary artery, i.e., posterior and lateral cord respectively. Aforesaid objectives were assessed. SPSS (Version 15.0) statistical package was used. Comparison between Group L and P was by using student's unpaired test for age and weight. Fisher's exact probability test was applied to compare percentages between groups.
Blocks of both groups were equally successful. No patient required intraoperative rescue analgesia. Duration of analgesia was comparable. Both groups had no major complications and similar postoperative pain scores.
The success rate of infraclavicular brachial plexus block by aiming at the lateral and posterior cord was similar.
成人锁骨下臂丛神经阻滞最有效的方法是将局麻药物注射至通常位于腋动脉后方的后束。然而，我们并不清楚这一方法是否适用于儿童。我们的主要目的是比较超声引导下将局麻药物注射至两个靶点的锁骨下臂丛神经阻滞在儿童中的临床成功率。这两个靶点分别是腋动脉后方（后束）和腋动脉外侧（外侧束）。次要目的包括术中补救镇痛的需求、镇痛持续时间的评估、气胸和动脉穿刺等并发症的发生率、术后疼痛评分的比较，同时也观察了透视下染料扩散模式。
这是一项随机、前瞻性的试点研究。40例接受前臂和手部手术的儿童根据神经阻滞的靶点部位随机分为两组。P组（20例患者）和L组（20例患者）的靶点部位分别是腋动脉后方和外侧，即分别为后束和外侧束。对上述目的进行评估。使用SPSS（15.0版）统计软件包。L组和P组之间的年龄和体重比较采用学生独立样本t检验。两组之间的百分比比较采用Fisher精确概率检验。
两组神经阻滞的成功率相同。没有患者需要术中补救镇痛。镇痛持续时间相当。两组均无严重并发症，术后疼痛评分相似。
将局麻药物注射至外侧束和后束的锁骨下臂丛神经阻滞成功率相似。
