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KMID : 1155520190140030280
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Anesthesia and Pain Medicine
2019 Volume.14 No. 3 p.280 ~ p.287
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Postoperative pain control by ultrasound guided brachial plexus block reduces emergence delirium in pediatric patients
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Hong Boo-Hwi
Jung Choon-Ho
Jo Yu-Min
Youn Soo-Kyoung
Kim Yeo-Jung
Chung Woo-Suk
Yoon Seok-Hwa
Shin Hyun-Dae
Lim Chae-Seong
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Abstract
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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.
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KEYWORD
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Brachial plexus block, Child, Emergence delirium, General anesthesia
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