Brachial plexus anaesthesia in children: lateral infraclavicular vs axillary approach.
BACKGROUND
Brachial plexus blockade is a well-established technique in upper-limb surgery. In paediatric patients, the axillary route is usually preferred to infraclavicular approaches because of safety considerations. Recent reports on a lateral infraclavicular approach offering greater safety in adults prompted us to perform a prospective randomized study to assess the analgesic efficacy of axillary vs lateral vertical infraclavicular brachial plexus (LVIBP) blocks in paediatric trauma surgery.


METHODS
Forty paediatric trauma patients (ASA physical status I and II, age range 1-10 years) scheduled for forearm or hand surgery were randomly assigned to either axillary brachial plexus (ABP group) or LVIBP group blocks using 0.5 ml.kg(-1) ropivacaine 0.5%. Sensory blockade was evaluated by a visual analogue score and Vester-Andersen's criteria, the distribution of sensory and motor blockade was evaluated by a simplified pinprick test and motor tests.


RESULTS
In the LVIBP group, Vester-Andersen's criteria were met by 100% of children, compared with 80% in the ABP group (P=0.035). Based on all assessable children, sensory blockade in the primary sensory regions of various nerves was significantly more effective in the LVIBP group (axillary: P < 0.0001; musculocutaneous: P=0.002; medial brachial cutaneous; P=0.008). Motor blockade was also significantly more effective (axillary: P < 0.0001; musculocutaneous: P=0.003). No major complications were observed in either group.


CONCLUSIONS
We conclude that LVIBP blocks can be safely performed in children and that they add to the spectrum of sensory and motor blockade seen with the axillary approach.
Fleischmann
E
E
Department of Anaesthesia and General Intensive Care Medicine, Medical School, University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
Marhofer
P
P
Greher
M
M
Waltl
B
B
Sitzwohl
C
C
Kapral
S
S
D000758:Anesthesia; D001365:Axilla / Q000294:innervation; D001917:Brachial Plexus / Q000502:physiology*; D002648:Child; D002675:Child, Preschool; D002968:Clavicle / Q000000981:diagnostic imaging / Q000294:innervation; D005260:Female; D005542:Forearm / Q000294:innervation / Q000601:surgery*; D006225:Hand / Q000294:innervation / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D009407:Nerve Block / Q000009:adverse effects / Q000379:methods*; D011446:Prospective Studies; D011859:Radiography; D013997:Time Factors