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Background and Aims The axillary brachial plexus block is a well established peripheral nerve block and analgesic method even in the pediatric population. We try to examine its efficacy under procedural sedation, with the patient breathing spontaneously.

Methods We retrospectively examined the data of 12 patients treated surgically for distal humeral fractures under procedural sedation and axillary plexus block. All patients rigorously followed NPO guidelines, and none of them had a history of vomiting or GERB. Two patients had a history of well controlled asthma, and one had a recent upper respiratory infection. The patients, aged 3 to 10 years old, were all preoxygenated, premedicated with atropine and received Propofol (2mg/kg) and Fentanyl (1,25-1,8mcg/kg) on induction. Adequate spontaneous breathing was confirmed and a continuous propofol infusion was maintained at 6-10mg/kg/h. An US-guided axillary brachial plexus block was performed using 1% Lidocaine (2-2,67mg/kg) and 0,5% Levobupivacaine (1,5-1,8mg/kg).

Results Intraoperatively analgesia was absolutely satisfactory, all patients maintained hemodynamic stability, breathing spontaneously with O2 support via mask (2L/min), without the need for additional analgesics or sedation. No respiratory complications were noted, and awakening upon surgery completion was uneventful.

Conclusions With the intraoperative and postoperative analgesic effects of the axillary plexus block being well established, our experience suggests that the block in combination with procedural sedation is a safe and effective method, potentially beneficial for patients at increased risk of complications after intubation or use of neuromuscular blockers. Rigorous attention must be directed towards determining the risk of regurgitation and aspiration.