Abstract：
The costoclavicular space serves as an alternative approach to the infraclavicular brachial plexus block, and numerous studies in adults have demonstrated promising outcomes for distal upper limb surgery. Blocking the brachial plexus at this level is potentially advantageous because the cords are relatively superficial, located in close proximity to each other and easily identified using ultrasound.
This study aimed to assess the success rate and feasibility of costoclavicular block in children undergoing unilateral below elbow upper limb surgery.
Thirty children aged 2-12 years scheduled for unilateral below elbow surgery under general anesthesia were included. Costoclavicular block was performed under ultrasound and nerve stimulator guidance with 0.5% ropivacaine, 0.5 mL/kg. Success was evaluated based on the absence of significant hemodynamic response to skin incision made 20 min after the block. The sono-anatomy of costoclavicular space, ease of needling, complications, and the post-operative pain scores were assessed.
The mean age and weight of the children were 6.5 ± 3.8 years and 19.7 ± 9.1 kg, respectively. The success rate of costoclavicular block in our cohort is 100%. Sonographic visualization was graded as excellent (Likert Scale 2) in 90% of cases. The plexus was located at a depth of 1.4 ± 0.3 cm from the skin, the lateral extent of cords from the artery was 0.8 ± 0.4 cm and they were observed inferior and lateral to the artery. The mean needling time was 3.6 ± 1.1 min. None of the children experienced complications such as vascular or pleural puncture, hematoma, Horner\'s syndrome or diaphragmatic palsy. Postoperative pain scores were low, and no rescue analgesia was required.
In conclusion, the costoclavicular block exhibited a notably high success rate in pediatric population. This study substantiates that the three cords of the brachial plexus are consistently visible and superficial during ultrasound examination using this approach, confirming their separation from vascular structures and the reliable achievement of blockade without observed complications.
This study aimed to assess the success rate and feasibility of costoclavicular block in children undergoing unilateral below elbow upper limb surgery.
Thirty children aged 2-12 years scheduled for unilateral below elbow surgery under general anesthesia were included. Costoclavicular block was performed under ultrasound and nerve stimulator guidance with 0.5% ropivacaine, 0.5 mL/kg. Success was evaluated based on the absence of significant hemodynamic response to skin incision made 20 min after the block. The sono-anatomy of costoclavicular space, ease of needling, complications, and the post-operative pain scores were assessed.
The mean age and weight of the children were 6.5 ± 3.8 years and 19.7 ± 9.1 kg, respectively. The success rate of costoclavicular block in our cohort is 100%. Sonographic visualization was graded as excellent (Likert Scale 2) in 90% of cases. The plexus was located at a depth of 1.4 ± 0.3 cm from the skin, the lateral extent of cords from the artery was 0.8 ± 0.4 cm and they were observed inferior and lateral to the artery. The mean needling time was 3.6 ± 1.1 min. None of the children experienced complications such as vascular or pleural puncture, hematoma, Horner\'s syndrome or diaphragmatic palsy. Postoperative pain scores were low, and no rescue analgesia was required.
In conclusion, the costoclavicular block exhibited a notably high success rate in pediatric population. This study substantiates that the three cords of the brachial plexus are consistently visible and superficial during ultrasound examination using this approach, confirming their separation from vascular structures and the reliable achievement of blockade without observed complications.
摘要：
背景：锁骨间隙是锁骨下臂丛神经阻滞的替代方法，在成人中进行的大量研究已经证明上肢远端手术有希望的结果.在这一水平上阻断臂丛神经可能是有利的，因为臂丛神经索相对较浅，位于彼此靠近，并使用超声波容易识别。
目的：本研究旨在评估儿童单侧肘下上肢手术的前锁骨阻滞成功率和可行性。
方法：30名年龄在2-12岁的儿童计划在全身麻醉下进行单侧肘关节以下手术。在超声和神经刺激器引导下用0.5%罗哌卡因行锁骨阻滞,0.5mL/kg。基于阻断后20分钟对皮肤切口没有明显的血液动力学反应来评估成功。锁骨间隙的声学解剖学，易于针刺，并发症,评估术后疼痛评分。
结果：儿童的平均年龄和体重分别为6.5±3.8岁和19.7±9.1kg，分别。在我们的队列中，锁骨阻滞的成功率为100％。在90％的病例中，超声显像被评为优秀（李克特量表2）。神经丛位于距皮肤1.4±0.3cm的深度，从动脉开始的索的外侧范围为0.8±0.4cm，它们在动脉下方和外侧观察到。平均针刺时间为3.6±1.1分钟。没有孩子出现血管或胸膜穿刺等并发症，血肿,霍纳综合征或膈肌麻痹。术后疼痛评分较低，不需要抢救镇痛。
结论：结论：在儿科人群中，锁骨阻滞的成功率非常高。这项研究证实，使用这种方法进行超声检查时，臂丛神经的三根索始终可见且浅表。确认它们与血管结构的分离以及可靠的阻断实现，而没有观察到的并发症。
目的：本研究旨在评估儿童单侧肘下上肢手术的前锁骨阻滞成功率和可行性。
方法：30名年龄在2-12岁的儿童计划在全身麻醉下进行单侧肘关节以下手术。在超声和神经刺激器引导下用0.5%罗哌卡因行锁骨阻滞,0.5mL/kg。基于阻断后20分钟对皮肤切口没有明显的血液动力学反应来评估成功。锁骨间隙的声学解剖学，易于针刺，并发症,评估术后疼痛评分。
结果：儿童的平均年龄和体重分别为6.5±3.8岁和19.7±9.1kg，分别。在我们的队列中，锁骨阻滞的成功率为100％。在90％的病例中，超声显像被评为优秀（李克特量表2）。神经丛位于距皮肤1.4±0.3cm的深度，从动脉开始的索的外侧范围为0.8±0.4cm，它们在动脉下方和外侧观察到。平均针刺时间为3.6±1.1分钟。没有孩子出现血管或胸膜穿刺等并发症，血肿,霍纳综合征或膈肌麻痹。术后疼痛评分较低，不需要抢救镇痛。
结论：结论：在儿科人群中，锁骨阻滞的成功率非常高。这项研究证实，使用这种方法进行超声检查时，臂丛神经的三根索始终可见且浅表。确认它们与血管结构的分离以及可靠的阻断实现，而没有观察到的并发症。
