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Abstract
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Background and Aims Open humerus fractures occur in high energy major trauma. The incident rate in children is rare (<10%) predominantly between 9y and 15y of age. Pediatric analgesia, especially regional anesthesia and the use of peripheral nerve catheters is challenging but beneficial. Ultrasound guidance precises catheter placement, its effectiveness and sufficiency.
Methods 13y old boy, 62kg, suffers isolated open humerus fracture after car accident with metal platform hitting the car. He had 5/5cm bleeding lacerated wound in lateral humerus with preserved circulation, radial nerve contusion, restricted wrist and thumb extension. Initial treatment included wound debridement and external fixation of the fracture under general anesthesia. At the end of the procedure an US- guided intrascalene catheter was placed (4cm depth) followed up by bolus of Lidocaine 50mg+Ropivacaine 25mg and continuous infusion of Ropivacaine 0.1% V= 6ml/h. Patient needed no additional analgesia during the first postoperative day. He underwent second final surgery two days later, requiring catheter removal. Fracture was fixed with two intramedullary nails with no nerve palsy and no bleeding. Postoperative pain control included fractured doses of intravenous paracetamol and tramadol.
Results Patient remained calm and pain free during the first postoperative day with subjective pain score of 0-1 points (Visual Analogue Scale). Analgesia continued orally and intravenously after catheter removal and bone repairing.
Conclusions Open proximal humerus fractures in children are uncommon and therefore challenging for treatment and pain control. External fixation is adequate initial treatment option but requires potent analgesia. US- guided intrascalene catheter s convenient and effective method for pain control.