Gao Tianyi, Song Zhuorun, Lu Shunyi, Song Nan, Yu Wentao, Yang Huilin, Zou Jun, Wang Qian, Ge Jun
Department of Anesthesia, Children's Hospital of Soochow University, Suzhou, Jiangsu, China.
Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
Front Pediatr. 2025 Apr 24;13:1485277. doi: 10.3389/fped.2025.1485277. eCollection 2025.
Perioperative pain management in children with Gartland Type III supracondylar humerus fractures (SHF) is crucial but often inadequately addressed, leading to significant pain experiences. This study aimed to evaluate the efficacy and safety of coracobrachialis plane musculocutaneous nerve block (Cora-MNB) compared to supraclavicular brachial plexus block (SC-BPB) for analgesia in pediatric Gartland Type III SHF patients.
A prospective pilot study enrolled 105 pediatric patients with Gartland Type III SHF was performed. Primary outcome was the postoperative FLACC scale measured at 12 h postoperatively. Secondary outcomes included FLACC scale measured at 1 h, 6 h and 24 h postoperatively. They also included postoperative thumb and shoulder strength, opioid use, NSAIDs use, length of hospital stays, patient satisfaction, surgeon satisfaction, operation time and puncture channels. One hundred and five patients were randomized allocated between groups.
Patients receiving Cora-MNB showed superior analgesia, with median postoperative FLACC pain scores at 12 h reduced by 40% [Cora-MNB: 3.00 (2.00) vs. SC-BPB: 5.00 (2.00), *** < 0.001]. Thumb extensor weakness incidence decreased significantly (Cora-MNB: 13.5% vs. SC-BPB: 84.9%, *** < 0.001). Shoulder mobility preservation was achieved in 98.08% of Cora-MNB cases vs. 20.75% with SC-BPB (*** < 0.001). While opioid consumption showed no intergroup difference, Cora-MNB reduced NSAID rescue times [Cora-MNB: 0.00 (1.00) vs. SC-BPB: 1.00 (1.00), ** = 0.0014]. Procedure duration favored Cora-MNB [4.54 ± 1.21 (min) vs. 9.02 ± 1.94 (min), T = 14.32, 95% CI: 3.88-5.12, *** < 0.001], with higher surgical and parental satisfaction scores. Hospital stays remained comparable [1.60 ± 0.66 (days) vs. 1.56 ± 0.67 (days), = 0.98].
Cora-MNB proves to be a safe and effective approach for anesthesia in pediatric SHF cases, offering superior analgesic outcomes, reduced NSAIDs usage, improved shoulder functionality, and high satisfaction levels without extending the hospital stay. This study supports the implementation of Cora-MNB as a valuable technique in perioperative pain management for pediatric SHF patients.
对于患有Gartland III型肱骨髁上骨折（SHF）的儿童，围手术期疼痛管理至关重要，但往往处理不当，导致明显的疼痛体验。本研究旨在评估与锁骨上臂丛神经阻滞（SC-BPB）相比，喙肱肌平面肌皮神经阻滞（Cora-MNB）用于小儿Gartland III型SHF患者镇痛的有效性和安全性。
进行了一项前瞻性试点研究，纳入105例患有Gartland III型SHF的儿科患者。主要结局是术后12小时测量的术后FLACC量表。次要结局包括术后1小时、6小时和24小时测量的FLACC量表。它们还包括术后拇指和肩部力量、阿片类药物使用、非甾体抗炎药使用、住院时间、患者满意度、外科医生满意度、手术时间和穿刺途径。105例患者被随机分组。
接受Cora-MNB的患者显示出更好的镇痛效果，术后12小时的FLACC疼痛评分中位数降低了40%[Cora-MNB：3.00（2.00）vs.SC-BPB：5.00（2.00），<0.001]。拇指伸肌无力发生率显著降低（Cora-MNB：13.5% vs.SC-BPB：84.9%，<0.001）。Cora-MNB组98.08%的病例实现了肩部活动度的保留，而SC-BPB组为20.75%（<0.001）。虽然阿片类药物的消耗量在组间没有差异，但Cora-MNB减少了非甾体抗炎药的补救次数[Cora-MNB：0.00（1.00）vs.SC-BPB：1.00（1.00），=0.0014]。手术持续时间有利于Cora-MNB[4.54±1.21（分钟）vs.9.02±1.94（分钟），T=14.32，95%CI：3.88-5.12，**<0.001]，手术和家长满意度评分更高。住院时间保持相当[1.60±0.66（天）vs.1.56±0.67（天），=0.98]。
Cora-MNB被证明是小儿SHF病例麻醉的一种安全有效的方法，具有更好的镇痛效果、减少非甾体抗炎药的使用、改善肩部功能以及高满意度，且不延长住院时间。本研究支持将Cora-MNB作为小儿SHF患者围手术期疼痛管理的一种有价值的技术加以应用。
