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Abstract
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Background and Aims We present the case of successful analgesia with infraclavicular peripheric nerve block in a 9-year-old female patient with Osteogenesis Imperfecta and Autistic Spectrum Disorder who underwent surgery for right elbow avulsion fraction.
Methods Before the procedure, the patient was premedicated with a 5 mg/kg ketamine intramuscular injection. After an adequate sedation level was achieved she received general anesthesia with sevoflurane inhalation induction and a laryngeal mask was placed. Because of abnormalities in connective tissue in these patients, there may be intravenous catheter placement challenges and difficulties performing neuraxial and peripheral nerve blocks. We performed an ultrasound-guided infraclavicular block using the costoclavicular approach. Synchronos to ultrasound a peripheral nerve stimulator was used to confirm the right placement of the needle and a single injection of 20 ml of 0.25% bupivacaine was made.
Results No complications were seen during and after the procedure. The patient was calm at the end of the operative period with an Aldrete score of 10 and Richmond Agitation and sedation scale of -1. She was discharged home uneventfully 6 hours after the operation and described little to no pain during her check-up one day after the operation.
Conclusions Regional anesthesia management in pediatric patients with Osteogenesis Imperfecta and Autistic Spectrum Disorder can be challenging but with ultrasound-guided peripheric blocks the risk of complications and the postoperative pain incidence can be decreased. We think our case can be a contribution to literature because there are no established guidelines regarding regional anesthesia in the pediatric population.
Brachial plexus laterally to the axillary artery (AA) and axillary vein (AV)