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Background and Aims For over forty years, anesthesiologists of the institution have safely practiced the trans-arterial axillary brachial plexus block (ABPB) with intermediate-acting local anesthetic for forearm and elbow surgeries of pediatric patients. Recently, cases of neglected and complicated fractures with long operative times were encountered more frequently. This has rendered the duration of previous technique inadequate and has led to cases of unplanned conversion to general anesthesia. Technological advances in the latter years have enabled practitioners to administer long-acting local anesthestic for ABPB under ultrasound guidance. This study presents the outcomes of ultrasound-guided ABPB on pediatric patients in a tertiary orthopedic hospital.

Methods With the approval of Institutional Ethics Review Board, investigators reviewed the chart of patients aged 8-17 years old who underwent forearm and elbow surgery under ultrasound-guided ABPB using isobaric bupivacaine +/- lidocaine and adjuncts for the period of June-October 2022. Outcomes were described.

Results Forty five patients were included with an average age of 13.76 years, predominantly male (73.33%), majority classified as ASA I (88.89%). Average onset time was 26.44 minutes, with a mean duration of 15.87 and 19.91 hours for motor and sensory block, respectively. Eight patients (17.78%) required rescue medication for post-operative pain, while the majority (82.22%) did not. Long-acting local anesthetic was safely administered without adverse events. Vital signs remained stable.

Conclusions Ultrasound-guided ABPB provided safe motor and sensory block with adequate duration for pediatric patients aged 8-17 years old who underwent upper extremity surgery, supporting its effectiveness in achieving anesthesia and post-operative pain control.