Anesth Pain Med.  2019 Jul;14(3):280-287. 10.17085/apm.2019.14.3.280.

Postoperative pain control by ultrasound guided brachial plexus block reduces emergence delirium in pediatric patients

• Hong B
• Jung C
• Jo Y
• Youn S
• Kim Y
• Chung W
• Yoon SH
• Shin HD
• Lim CS

• KMID: 2454812
• DOI: http://doi.org/10.17085/apm.2019.14.3.280

Abstract

BACKGROUND
Pediatric patients awakening from general anesthesia may experience emergence delirium (ED), often due to inadequate pain control. Nerve block completely inhibits innervation of the surgical site and is superior to systemic analgesics. This study assessed whether pain control through nerve block relieves ED after general anesthesia.
METHODS
Fifty patients aged 2-7 years with humerus condyle fractures were randomly assigned to receive ultrasound guided supraclavicular brachial plexus block (BPB group) or intravenous fentanyl (Opioid group). The primary outcome was score on the pediatric anesthesia emergence delirium (PAED) scale on arrival at the postanesthesia care unit (PACU). Secondary outcomes were severity of agitation and pain in the PACU, the incidence of ED, and postoperative administration of rescue analgesics over 24 h.
RESULTS
PAED scale was significantly lower in the BPB group at arrival in the PACU (7.2 ± 4.9 vs. 11.6 ± 3.2; mean difference [95% confidence interval (CI)] = 4.4 [2.0-6.8], P < 0.001) and at all other time points. The rate of ED was significantly lower in the BPB group (36% vs. 72%; relative risk [95% CI] = 0.438 [0.219-0.876], P = 0.023). The BPB group also had significantly lower pain scores and requiring rescue analgesics than Opioid group in the PACU.
CONCLUSIONS
Ultrasound guided BPB, which is a good option for postoperative acute phase pain control, also contributes to reducing the severity and incidence of ED.

Keyword

Brachial plexus block; Child; Emergence delirium; General anesthesia

MeSH Terms

Analgesics
Anesthesia
Anesthesia, General
Brachial Plexus Block*
Brachial Plexus*
Child
Delirium*
Dihydroergotamine
Fentanyl
Humans
Humerus
Incidence
Nerve Block
Pain, Postoperative*
Ultrasonography*
Analgesics
Dihydroergotamine
Fentanyl

Figure

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  Fig. 1 Consolidated Standards of Reporting Trials flow diagram of study participants. BPB: brachial plexus block.

• 

  Fig. 2 Scores over time of patients in the brachial plexus block (BPB) and Opioid groups assessed using (A) the pediatric agitation and emergence delirium (PAED) scale and (B) the modified Children's Hospital of Eastern Ontario Pain (mCHEOP) scale. Values are presented as median (1Q, 3Q). *P < 0.05 between two groups.

• 

  Fig. 3 Kaplan–Meier survival analysis showing the proportion of patients in the brachial plexus block (BPB) and Opioid groups not requiring rescue analgesics over time, with comparison by the log-rank test.

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