comparison of lateral and medial approaches to costoclavicular brachial plexus block in pediatrics

Conditions: Anesthesia, Local; Postoperative Pain

Summary: in upper extremity surgeries, the brachial plexus block can be performed with different techniques at various levels depending on the proximal and distal level of the surgery. in this study, we aim to compare the different approaches of us guided costoclavicular technique. lateral approache is more common for the costoclavicular block area. however, more needle maneuvers are needed especially in pediatric patients because of the coracoid process. medial approach is recommended to overcome this problem. thus demonstrate the safety of upper extremity blocks, which is an important part of multimodal analgesia, and to determine the most ideal technique in the pediatric patient group who will undergo upper extremity surgery. during the block application, the us imaging time, the difficulty level of needle imaging, the number of maneuvers required to reach the target image, whether additional maneuvers are required according to the local anesthetic distribution, the success of the block and the duration of the surgery, the total application time of the block and the duration of general anesthesia will be recorded. mean arterial pressure and heart rate will be recorded at 30-minute intervals during the surgery. standardized for pediatric patients the flacc and wong-baker pain scores will be followed first 24 hours after surgery. the patient will be examined for motor and sensation, and analgesic doses will be recorded if used. time to first pain identification, duration of sleep, patient and surgeon satisfaction will be recorded.

peripheral nerve blocks; it is widely used in daily practice for anesthesia or as a part of multimodal analgesia in most surgical procedures. in upper extremity surgeries, the brachial plexus block can be performed with different techniques at various levels depending on the proximal and distal level of the surgery. in this study, the aim is to compare postoperative analgesic effects of these two ultrasound-guided techniques in pediatric patients. in this study, we aim to compare the different approaches of us guided costoclavicular technique. lateral approache is more common for the costoclavicular block area. however, more needle maneuvers are needed especially in pediatric patients because of the coracoid process. medial approach is recommended to overcome this problem. thus demonstrate the safety of upper extremity blocks, which is an important part of multimodal analgesia, and to determine the most ideal technique in the pediatric patient group who will undergo upper extremity surgery. during the block application, the us imaging time, the difficulty level of needle imaging, the number of maneuvers required to reach the target image, whether additional maneuvers are required according to the local anesthetic distribution, the success of the block and the duration of the surgery, the total application time of the block and the duration of general anesthesia will be recorded. mean arterial pressure and heart rate will be recorded at 30-minute intervals during the surgery. standardized for pediatric patients the flacc and wong-baker pain scores will be followed first 24 hours after surgery. the patient will be examined for motor and sensation, and analgesic doses will be recorded if used. time to first pain identification, duration of sleep, patient and surgeon satisfaction will be recorded.

Eligibility criteria:
inclusion criteria: * undergoing unilateral upper extremity surgery (distal midhumerus). * asa(american society of anesthesiology) 1-3 * receiving family consent from the parents that they accept regional analgesia exclusion criteria: - parents refusal * infection on the local anesthetic application area * infection in the central nervous system * coagulopathy * brain tumors * known allergy against local anesthetics * anatomical difficulties * syndromic patient

Keywords: postoperative analgesia upper extremity surgery costoclavicular block brachial plexus block ultrasound guidance