Brachial plexus block for perioperative analgesia in children with radial club hand: a retrospective audit

Objectives: Brachial plexus block in combination with general anaesthesia is used for surgical correction of radial club hand. We carried out this retrospective study to assess the feasibility and efficacy of brachial plexus block in children with radial club hand. Intraoperative and postoperative analgesic requirements were the primary outcome measures analysed. Methodology: We conducted a retrospective audit and collected data on the intraoperative and postoperative analgesic requirements in 24 patients anaesthetised for orthopedic treatment of this congenital deformity in our children's hospital over a period of 5 years. Results: Transarterial axillary block was administered to 8 patients; nerve stimulator guided supraclavicular block was used in 4 patients; and 12 were administered anesthesia without administration of brachial plexus block. Intraoperative additional supplementation of intravenous opioid was required in 12.5%, 50% and 75% of patients administered axillary block, supraclavicular block and no block (only general anesthesia) respectively. The mean time interval for administration of first dose of analgesic in postoperative period was 4.5, 3.6 and 0.75 hours respectively. Permanent diaphragmatic paralysis was reported in one patient with supraclavicular block. No complication was reported in the group with axillary block. Conclusion: Supplementation of general anesthesia with transarterial axillary brachial plexus block provides adequate perioperative analgesia in children with radial club hand operated for centralisation of ulna.