Document Detail


Continuous infraclavicular brachial plexus block: a modified technique to better secure catheter position in infants and children.
MedLine Citation:
PMID:  18165560     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: The infraclavicular approach to the brachial plexus provides suitable anesthesia and also lends itself well to stabilizing and securing a catheter for a continuous infusion. We describe an approach for continuous infusions using an infraclavicular approach in children. METHODS: Twenty-five patients aged 8 mo to 3 yr, weighing 7-14 kg, scheduled for forearm and hand surgeries were studied. The infraclavicular brachial plexus was located using a nerve stimulator attached to a sheathed 19-gauge Touhy needle. The needle was inserted through the skin at 1 cm below and 1 cm lateral to the midpoint of the clavicle. The needle was advanced and directed toward the coracoid process maintaining an angle of 30 degrees with the skin. A 20-gauge epidural catheter was passed to the 5-7 cm mark through the Touhy needle. The Touhy needle was removed and the catheter left in place. Bupivacaine (1 mL/kg; 0.25%) was administered through the catheter. A continuous infusion of 0.25 mg/kg/h of bupivacaine (0.125%) was commenced near the end of surgery and continued on the first postoperative day. The continuous infusion was discontinued on the second postoperative day and intermittent boluses were administered every 4 to 6 h. In all patients the catheter was removed after 48 h. RESULTS: Twenty-four patients (96%) had a successful block. On the first postoperative day all patients were pain free (Children's Hospital Eastern Ontario Pain Scale score 4-6). On the second day, two children (8%) needed ibuprofen syrup along with a supplemental dose of local anesthesia. The catheter was passed with ease in all but four children. However, in these four patients, slight needle angulation and a bolus of 1-2 mL local anesthetic solution was required to overcome the resistance. None of the patients had catheter dislodgements or accidental removal, hemorrhagic tap, or pneumothorax. CONCLUSIONS: A modified technique for continuous infraclavicular brachial plexus block helps secure the catheter and provides effective intra- and postoperative pain relief in pediatric patients.
Authors:
Vrushali C Ponde
Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  Anesthesia and analgesia     Volume:  106     ISSN:  1526-7598     ISO Abbreviation:  Anesth. Analg.     Publication Date:  2008 Jan 
Date Detail:
Created Date:  2007-12-31     Completed Date:  2008-10-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  1310650     Medline TA:  Anesth Analg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  94-6, table of contents     Citation Subset:  AIM; IM    
Affiliation:
Department of Anesthesiology, All India Institute of Physical Medicine and Rehabilitation, Mumbai, India. vrushaliponde@yahoo.co.in
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MeSH Terms
Descriptor/Qualifier:
Anesthetics, Local / administration & dosage*
Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
Brachial Plexus*
Bupivacaine / administration & dosage*
Catheterization / instrumentation*
Catheters, Indwelling*
Child, Preschool
Clavicle
Device Removal
Humans
Ibuprofen / therapeutic use
Infant
Infusions, Parenteral
Nerve Block / methods*
Pain Measurement
Pain, Postoperative / prevention & control*
Time Factors
Treatment Outcome
Upper Extremity / innervation*,  surgery
Chemical
Reg. No./Substance:
0/Anesthetics, Local; 0/Anti-Inflammatory Agents, Non-Steroidal; 15687-27-1/Ibuprofen; 2180-92-9/Bupivacaine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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