One additional shot of brachial plexus block equates to less postoperative pain for younger children with elbow surgeries

Jin Li; Saroj Rai; Ruikang Liu; Ruijing Xu; Pan Hong

doi:10.1186/s13018-020-01778-4

One additional shot of brachial plexus block equates to less postoperative pain for younger children with elbow surgeries

J Orthop Surg Res. 2020 Jul 6;15(1):246. doi: 10.1186/s13018-020-01778-4.

Authors

Jin Li¹, Saroj Rai², Ruikang Liu³, Ruijing Xu¹, Pan Hong⁴

Affiliations

¹ Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
² Department of Orthopaedics and Trauma Surgery, National Trauma Center, National Academy of Medical Sciences, Mahankal, Kathmandu, Nepal.
³ First School of Clinical Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
⁴ Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China. hongpan2013@foxmail.com.

Abstract

Background: Postoperative pain in children has always been inadequately evaluated. This study aims to evaluate the postoperative pain response using an additional dose of brachial plexus block (BPB) for younger children receiving elbow surgeries under general anesthesia (GA).

Methods: This retrospective case-control study included pediatric patients (3-10 years) who underwent surgeries for elbow injuries between January 2015 and January 2019. Patients with previous history of surgeries around the elbow, neurological impairment of injured limb, polytrauma, undergoing pain management for different causes, and open or old fractures were excluded. Patients were dichotomized into the GA group and the GA + BPB group as per the presence or absence of BPB.

Results: In all, 150 patients (102/48, male/female) in the GA and 150 patients (104/46, male/female) in the GA + BPB group were included. There existed no significant differences between the two groups in age, sex, fracture side, and types of elbow procedures. As for the pain response after lateral condyle fracture of the humerus (LCFH), the FLACC pain scale was significantly higher for those in the GA group (6.2 ± 0.8) when compared to the GA + BPB group (1.6 ± 0.5) (P < 0.001). As for the pain response after medial epicondyle fracture of the humerus (MCFH), the FLACC pain scale was significantly higher for those in the GA group (6.0 ± 0.8) when compared to the GA + BPB group (1.5 ± 0.5) (P < 0.001). As for the pain response after supracondylar fracture of the humerus (SCFH), the FLACC pain scale was significantly higher for those in the GA group (6.0 ± 0.8) when compared to the GA + BPB group (1.6 ± 0.5) (P < 0.001). As for the pain response after cubitus varus correction, the FLACC pain scale was significantly higher for those in the GA group (6.7 ± 0.7) when compared to the GA + BPB group (2.1 ± 0.7) (P < 0.001).

Conclusion: An additional shot of BPB for patients undergoing surgeries for elbow surgeries resulted in better postoperative pain response in younger children without significant BPB-related complications.

Keywords: Brachial plexus block; Children; General anesthesia; Postoperative pain.

MeSH terms

Age Factors
Anesthesia, General
Brachial Plexus Block / methods*
Case-Control Studies
Child
Child, Preschool
Elbow / surgery*
Elbow Injuries*
Female
Humans
Male
Pain, Postoperative / prevention & control*
Retrospective Studies
Treatment Outcome