Background and aims Since its first description in 2015,¹ ultrasound-guided costoclavicular brachial plexus block has been increasingly used for anaesthesia and analgesia of the upper limb. Nonetheless and to our knowledge, there are no reports of its use for pain management during physical therapy. Hereby we describe the first continuous ultrasound-guided costoclavicular brachial plexus block for physical rehabilitation after a traumatic elbow fracture in a child.

Methods A 12-year-old child, 30 kg, ASA I, suffered a traumatic elbow fracture-dislocation which was conservatively treated with closed reduction and immobilization. An intra-articular bone fragment precluded a successful rehabilitation after cast removal, which ultimately resulted in a significant post-traumatic painful stiffness of the elbow preventing further engagement in the rehabilitation process. We performed an ultrasound-guided perineural catheter insertion through a costoclavicular approach of brachial plexus. Boluses of 5 ml of ropivacaine 0,2% were administered 20 minutes prior each rehabilitation session, which allowed effective pain control during physiotherapy (Wong-Baker faces pain scale from 6 to 0 after regional analgesia) and a progressive gain in elbow range motion until then impossible.

Results Continuous costoclavicular peripheral nerve block was a successful alternative to pain management in this post-traumatic rehabilitation setting.

Conclusions Continuous regional analgesia through costoclavicular approach of brachial plexus may be a valuable option not only for pain control but also for improving functional prognosis during rehabilitation in the paediatric population.

Reference

1. Karmakar MK, Sala-Blanch X, Songthamwat B, Tsui BC. Benefits of the costoclavicular space for ultrasound-guided infraclavicular brachial plexus block: description of a costoclavicular approach. Reg Anesth Pain Med 2015;40:287–288.