Brachial plexus block with ultrasound guidance for upper-limb trauma surgery in children: a retrospective cohort study of 565 cases

Background: Upper-limb trauma is a common indication for surgery in children, and general anaesthesia remains the method of choice for these procedures, even though suitable techniques of brachial plexus block are available and fast provision of regional anaesthesia offers a number of distinct advantages.

Methods: A retrospective analysis was performed of the data of a large cohort of children undergoing ultrasound-guided brachial plexus blocks during a 4-yr period at a major trauma centre with a catchment area of 3.5 million. A total of 565 cases were sourced from two independently operating patient documentation systems. Patient data were stratified into age groups with block success as the primary outcome parameter. The influence of age on the incidence of block failure was assessed with logistic regression.

Results: The block failure rate was 5.1%, starting at 1.2% in the youngest (0-3 yr), then continuously increasing up to 12.5% in the oldest (15-18 yr) but also smallest group. Age emerged as an independent predictor of block failure with an odds ratio of 1.115 and a 95% confidence interval of 1.014-1.226 (P=0.025). No complications were observed.

Conclusions: In a cohort of children receiving real-world care, with regional blocks performed by a range of anaesthetists with different skill levels, a success rate of 94.9% for upper-limb blocks in children under various levels of sedation was observed. Upper-limb blocks can be performed with high probability of success and an excellent margin of safety; this particularly applies to small children.

Clinical trial registration: NCT03842423.