Publication: Brachial plexus block as a sole anaesthetic technique in upper extremity fracture/dislocation in children: Subclavian perivascular vs parascalene approach
Date
2006
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Kathmandu University
Abstract
Objective: To compare parascalene approach of brachial plexus block with the classical subclavian perivascular
approach as a sole anaesthetic technique in children undergoing closed manipulation for fracture/dislocation around
the elbow.
Materials and methods: Sixty children (age 6-13 years) undergoing closed manipulation for fracture/dislocation
around the elbow were randomly assigned to two groups, Group I (n=30) receiving brachial plexus block using
Winnie’s classical subclavian perivascular approach and Group II (n=30) receiving brachial plexus block using
parascalene approach described by Dalens. Time required for performing the block, onset of analgesia, sensory
block to pin prick, adequacy of relaxation, complications and acceptance of the technique to the children, parents
and the surgeons were compared.
Results: Time required for performing the block (6.3±2.2 min vs. 8.2±2.4 min), onset of subjective analgesia
(4.1±1.6 min vs. 5.2±1.4 min) and onset of sensory block to pinprick (6.8±2.1 min vs. 8.6±1.7 min) were
significantly shorter in Group I as compared to Group II (p<0.01). Acceptance of the techniques by the children,
parents and the surgeons, and the overall success rates were high and comparable between the groups.
Complications were minor and the incidence was low in both the groups except Horner’s syndrome in 46.7% of
patients in Group II.
Conclusion: Parascalene approach to brachial plexus block is comparable to classical subclavian perivascular
approach in safety, success rate and acceptance in children undergoing closed manipulation and reduction of
fracture/dislocation around the elbow.
Key words: brachial block, children, parascalene, regional anaesthesia
Description
Bhattarai BK 1
, Baral PR 2
1 Associate Professor, Department of Anaesthesiology and Critical Care, BP Koirala Institute of Health Sciences,
Dharan, Nepal, 2
Lecturer, Department of Anaesthesiology, Kathmandu University Medical School, Dhulikhel,
Kavre, Nepal.