A COMPARATIVE STUDY OF TWO DIFFERENT TECHNIQUES OF BRACHIAL PLEXUS BLOCK IN CHILDREN, INFRACLAVICULAR VS AXILLARY BLOCK

Abstract

Background: The potential benefits of using ultrasound guidance for regional blocks include the visualization of the surrounding structures (pleura, axillary artery and vein) and the real-time control of the needle movement. Objectives: to assure the introduction of ultrasonography to improve the ability to perform these blocks with greater ease and precision. Patients and methods: Forty pediatric patients of both sexes (ASA physical status I or II )who were scheduled for upper limb surgery at or below elbow.The ages of the patients were ranging from 5 to 15 years and their body weights from 15 to 55 kg,they were randomly allocated into two equal groups (20 patients each) by sealed envelope. These groups were: Infraclavicular group ( groupI) and Axillary group (A) in which both blocks was performed using ultrasound technique. All patients received oral midazolam 0.25 : 0.33 mg/kg as apremedication. All blocks were performed by US-guidance with a Mindray Sonoline unit (DP1100 china), a 5–9 MHz 35 mm linear probe and a short-bevelled needle with extension tube (25–22 G/35–50 mm), All patients were received a sleeping dose of ketamine 1mg/kg with oxygen mask applied then the block was performed. Maintenance of anesthesia was carried out with Isoflurane 1MAC in 50% oxygen/air until the end of the surgery an increase in heart rate or blood pressure ≥10% or an increase in respiratory rate ≥20% and this was considered failed block. Postoperative analgesia was evaluated using modified objective pain score in children from 5 to 10 years old and a numeric pain scale in older children. The following parameters were detected and recorded in each group: Block performance time, The success rate, The duration of sensory and motor blockade, Post-operative analgesia and associated side effects, Results: There were no statistically significant results as regard to intra and post-operative analgesia, duration of sensory and motor blockade, however infraclavicular block was quicker to perform compared with the axillary block (7.7±2.3 vs 8.6±3.5) ,higher success rate although non-significant for infraclavicular block compared to axillary block 95.5 vs 90.9 . there was one case of vascular puncture in the infraclavicular group and no vascular puncture in the axillary group. Conclusion: Ultrasound-guided infraclavicular BPB can reduce the performance time compared to ultrasound-guided axillary block and there was no significant difference in the success rate, duration of sensory and motor blockade and complications for both blocks. Keywords: pediatric regional, brachial plexus, ultrasound, infraclavicular, axillary.