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Inicio Revista Española de Anestesiología y Reanimación (English Edition) Anesthetic management using costoclavicular brachial plexus block with patient-c...
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Vol. 69. Issue 10.
Pages 705-707 (December 2022)
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Vol. 69. Issue 10.
Pages 705-707 (December 2022)
Case report
Anesthetic management using costoclavicular brachial plexus block with patient-controlled analgesia in Pediatrics: A case report
Tratamiento anestésico mediante bloqueo del plexo braquial costoclavicular con analgesia controlada por el paciente en Pediatría: caso clínico
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N. Tanaka
Corresponding author
nobuhirotanaka@naramed-u.ac.jp

Corresponding author.
, M. Ida, T. Nishiwada, M. Kawaguchi
Department of Anesthesiology, Nara Medical University, Kashihara, Nara, Japan
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Abstract

The costoclavicular brachial plexus block (CBPB) has been receiving increasing attention as an effective technique for upper arm surgery conducted without phrenic paralysis. However, studies in children are lacking. CBPB was applied to a 10 year-old girl undergoing scheduled radial and ulnar osteotomy due to multiple cartilaginous exostoses and ulnar lengthening. CBPB was performed with a bolus administration of 10 mL of 0.25% levobupivacaine, and the catheter was sequentially replaced in the right costoclavicular space. After surgery, a continuous infusion of 0.17% levobupivacaine through a catheter was initiated at 2 mL/h, along with patient-controlled analgesia (PCA) of 3 mL 0.17% levobupivacaine with a 60-min lock out. The patient complained of 5/10 pain on the numerical rating scale (NRS) 2 h after surgery, which improved immediately after bolus administration. The analgesia induced by CBPB was otherwise effective (NRS ≤ 2). CBPB with PCA may provide adequate analgesia in paediatric cases.

Keywords:
Peripheral nerve block
Costoclavicular brachial plexus block
Pediatric anesthesia
Resumen

El bloqueo del plexo braquial costoclavicular (CBPB) ha venido recibiendo atención creciente como técnica eficaz en la cirugía de la parte superior del brazo realizada sin parálisis frénica. Sin embargo, se carece de estudios en niños. Se realizó CBPB a una niña de 10 años sometida a osteotomía radial y ulnar programada, debido a exostosis múltiples cartilaginosos y elongación ulnar. Se realizó CBPB con administración de un bolo de 10 ml de levobupivacaína al 0,25%, sustituyéndose secuencialmente el catéter en el espacio costoclavicular derecho. Tras la cirugía, se inició infusión continua de 2 ml/h de levobupivacaína al 0,17% a través de catéter, junto con analgesia controlada por el paciente (PCA) de 3 ml de levobupivacaína al 0,17% con bloqueo de 60 minutos. La paciente se quejó de dolor de nivel 5/10 de la escala numérica (NRS) transcurridas dos horas de la cirugía, que mejoró inmediatamente tras la administración del bolo. Por lo demás, la analgesia inducida por CBPB fue efectiva (NRS ≤ 2). El CBPB con PCA puede aportar una analgesia adecuada en casos pediátricos.

Palabras clave:
Bloqueo del nervio periférico
Bloqueo del plexo braquial costoclavicular
Anestesia pediátrica

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