Comparative evaluation of brachial plexus block efficiency depending on the variant of nerve verification in infants
Abstract
Introduction. In infancy brachial plexus blocks are usually performed under deep sedation or inhalation anesthesia. The use of a nerve stimulator for nerve plexus verification does not protect against the complications related to the technique. The use of ultrasound has some advantages: the time spent for the block performance is shorter, the percentage of successful anesthesia – higher, and the volume of local anesthetic – less. Many authors consider the combined use of ultrasound and a neurostimulator to be the most optimal variant.
Purpose. Comparative evaluation of peripheral block efficiency depending on the technique of brachial plexus verification for surgical corrections of the hand congenital deformities in infants.
Methods. Thirty infants and young children studied. Brachial plexus blocks performed using supraclavicular approach with ropivacaine at the dose of 2 mg/kg. The plexus verification performed using ultrasound navigation and neurostimulation in the first group (15 children); and using neurostimulation alone – in the second group (15 childtren).
Results. Wholly efficiency of the blocks observed in the patients from the main group, that was 93,3% in the patients from control group. The reliable decrease of the heart rate (HR) and respiration rate (RR) up to the age-related norm documented at all the stages of surgical intervention in the both groups. The stability of the values of central hemodynamics, respiration, oxygen delivery index observed, and the balance of acid-base state and lactate level maintained through these values. The normal balance of sympathetic and parasympathetic activity of the vegetative nervous system (VNS) in the main and control groups evidences of anesthesia adequate level.
Conclusion. The use of ultrasound for brachial plexus block allows direct nerve and tissue visualization, as well as anesthetic spread controlling, thereby making it possible to minimize the number of potential complications and to increase the block efficiency significantly. Brachial plexus block provides adequate protection of the child from surgical injury.
Purpose. Comparative evaluation of peripheral block efficiency depending on the technique of brachial plexus verification for surgical corrections of the hand congenital deformities in infants.
Methods. Thirty infants and young children studied. Brachial plexus blocks performed using supraclavicular approach with ropivacaine at the dose of 2 mg/kg. The plexus verification performed using ultrasound navigation and neurostimulation in the first group (15 children); and using neurostimulation alone – in the second group (15 childtren).
Results. Wholly efficiency of the blocks observed in the patients from the main group, that was 93,3% in the patients from control group. The reliable decrease of the heart rate (HR) and respiration rate (RR) up to the age-related norm documented at all the stages of surgical intervention in the both groups. The stability of the values of central hemodynamics, respiration, oxygen delivery index observed, and the balance of acid-base state and lactate level maintained through these values. The normal balance of sympathetic and parasympathetic activity of the vegetative nervous system (VNS) in the main and control groups evidences of anesthesia adequate level.
Conclusion. The use of ultrasound for brachial plexus block allows direct nerve and tissue visualization, as well as anesthetic spread controlling, thereby making it possible to minimize the number of potential complications and to increase the block efficiency significantly. Brachial plexus block provides adequate protection of the child from surgical injury.
Review
For citations:
, Comparative evaluation of brachial plexus block efficiency depending on the variant of nerve verification in infants. Genij Ortopedii. 2014;(2). (In Russ.)
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