| Continuous infraclavicular brachial plexus block: a modified technique to better secure catheter position in infants and children. | |
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MedLine Citation:
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PMID: 18165560 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Vrushali C Ponde |
Publication Detail:
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Type: Clinical Trial; Journal Article |
Journal Detail:
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Title: Anesthesia and analgesia Volume: 106 ISSN: 1526-7598 ISO Abbreviation: Anesth. Analg. Publication Date: 2008 Jan |
Date Detail:
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Created Date: 2007-12-31 Completed Date: 2008-10-22 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 1310650 Medline TA: Anesth Analg Country: United States |
Other Details:
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Languages: eng Pagination: 94-6, table of contents Citation Subset: AIM; IM |
Affiliation:
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Department of Anesthesiology, All India Institute of Physical Medicine and Rehabilitation, Mumbai, India. vrushaliponde@yahoo.co.in |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Anesthetics, Local
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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:
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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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