Feasibility and safety of ultrasound-guided supra-clavicular block in children

• Published in: Perioperative care and operating room management 2024-12, Vol.37, p.100422, Article 100422
• Main Authors: Ben Slimene, Ahmed, Trifa, Mehdi, Blaiti, Hajer, Aouadi, Salma, Beji, Adel, Ben Hafsa, Mohamed Amine, Cox, Joshua D
• Format: Article
• Language: English
• Subjects: Child; Nerve block; Safety
• ISSN: 2405-6030; 2405-6030
• DOI: 10.1016/j.pcorm.2024.100422

Ultrasound-guided supra-clavicular nerve block (SCNB) has regained interest in adults but remains underutilized in pediatrics. This case series aims to evaluate the efficacy and safety of ultrasound-guided SCNB in children undergoing upper-extremity surgery. Prospective observational case series, the inclusion criteria were children over one year old who were scheduled for elective upper-extremity surgery. After induction of general anesthesia, an ultrasound-guided SCNB was performed. A dose of 0.2–0.5 ml/kg of bupivacaine 0.25 % or ropivacaine 0.2 % was administered all around the brachial plexus. In case of postoperative pain, 15 mg kg-1 of paracetamol + 10 mg kg-1 of ibuprofen were administered. The primary outcome measure was the success and safety of the block. Secondary outcomes were time to first analgesia administration and duration of motor blockade. Thirty-three patients were included. Median age and weight were 6 [2.75,9.75] years and 24 [16,35] kg, respectively with a sex ratio of 3.1. Bupivacaine 0.25 % was used in the majority of cases (N = 24). The overall duration to complete block performance was 170 [120,300] seconds. A single attempt was sufficient for the majority of children, with a block success rate of 100 %. No incidents were reported during block performance. Postoperatively, time to the first analgesic request was 10 [8,12.5] hours. Twenty-five patients developed a motor block, with a duration of 4 [0.5,5] hours. Bupivacaine 0.25 % was associated with higher incidence of motor blockade (p = 0.002). Ultrasound-guided SCNB appears to be an effective and safe technique in children. Further studies using lower doses of bupivacaine could help reduce the incidence of motor block.