Supraklavikularni blok sa perineuralnim kateterom kod deteta sa dvostrukim prelomom lakta i podlaktice - prikaz slučaja

Abstract

Introduction: Ultrasound-guided supraclavicular block with perineural catheter placement has enabled a significant reduction in block-related complications, as well as far better perioperative pain management. Case report: A 9-year-old boy was admitted for a combined forearm/elbow fracture, with a history of laryngitis. As a result, we opted to perform an ultrasound-guided supraclavicular brachial plexus block under procedural sedation, with the placement of a perineural catheter. We used 25 mL of 0,5% Levobupivacaine. Orthopedic repositioning and internal fixation were performed under procedural sedation and the supraclavicular block with monitoring of basic vital parameters. Throughout the procedure, the patient maintained hemodynamic and respiratory stability, and the pain was postoperatively managed with a continuous Levobupivacaine infusion at 0,2-0,5 mg/kg/h. The patient was discharged on the fifth postoperative day. Discussion: Although information is limited regarding peripheral nerve block in the pediatric population their use in adults is well established, as is a higher degree of skill necessary for their administration in children due to clear anatomic nuance. The utilization of peripheral nerve blocks reduces the incidence of postoperative nausea and vomiting, as well as the use of opioid or nonopioid rescue analgesia. Their benefit is additionally underlined by the fact that adequate postoperative analgesia can reduce exaggerated responses to pain later in life. Conclusion: Ultrasound-guided supraclavicular brachial plexus block with placement of a perineural catheter provides safe and effective perioperative analgesia in children with fractures at or below the level of the humerus.