title: Feasibility, efficacy, and safety of ultrasound-guided axillary plexus blockade in pediatric patients with epidermolysis bullosa dystrophica.
abstract: BACKGROUND
  In patients suffering from epidermolysis bullosa dystrophica (DEB), the most severe form of epidermolysis bullosa, trauma or friction cause separation of the skin from underlying tissue with consecutive painful blisters, scarifications, contractures, and pseudosyndactyly. To retain functionality of the hands surgical procedures are necessary. Anesthesia is challenging as difficult airways make general anesthesia risky. Regional anesthesia is considered controversial in patients with EB as accidental subcutaneous injections can cause severe blisters. As ultrasound-guided procedures became standard of care this might have changed however.
  
  
  OBJECTIVE
  In this case series, we describe feasibility, efficacy, and safety of ultrasound-guided plexus axillaris block in DEB patients undergoing hand surgery.
  
  
  METHODS
  We performed a retrospective analysis of the charts of all children with DEB undergoing hand surgery under plexus axillaris block and sedation between 2009 and 2013 in our institution.
  
  
  RESULTS
  Nineteen procedures in nine children were performed. Induction of anesthesia (securing monitoring, sedation, plexus block) took a mean time of 34 min. Perioperative analgesia was adequate in all procedures. No complications such as airway incidents, conversion to general anesthesia, movement during surgery, incomplete block, or formation of new blisters were seen.
  
  
  CONCLUSIONS
  Ultrasound-guided plexus axillaris block in DEB patients undergoing hand surgery in our institution has been feasible, effective, and safe.
authors: Department of General Pediatrics, University Children's Hospital Muenster, Muenster, Germany.
authors: Ingeborg
authors: I
authors: van den Heuvel
authors: Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Muenster, Muenster, Germany.
authors: Antje
authors: A
authors: Gottschalk
authors: Department of Trauma-, Hand- and Reconstructive Surgery, Westfaelische Wilhelms-University Muenster, Muenster, Germany.
authors: Martin
authors: M
authors: Langer
authors: Department of Anesthesiology, University Medicine Greifswald, Greifswald, Germany.
authors: Klaus
authors: K
authors: Hahnenkamp
authors: Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Muenster, Muenster, Germany.
authors: Björn
authors: B
authors: Ellger
mesh_terms: D001365:Axilla; D002648:Child; D054810:Deep Sedation; D016108:Epidermolysis Bullosa Dystrophica / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006225:Hand / Q000601:surgery*; D006801:Humans; D008297:Male; D009407:Nerve Block / Q000009:adverse effects / Q000379:methods*; D010149:Postoperative Pain / Q000188:drug therapy / Q000453:epidemiology; D012189:Retrospective Studies; D018084:Ultrasonography, Interventional
keywords: axillary block; epidermolysis bullosa; hand surgery; regional anesthesia; sedation; ultrasound