Brachial plexus block as a sole anaesthetic technique in upper extremity fracture/dislocation in children: subclavian perivascular vs parascalene approach.

OBJECTIVE To compare parascalene approach of brachial plexus block with the classical subclavian perivascular approach as a sole anaesthetic technique in children undergoing closed manipulation for fracture/dislocation around the elbow. MATERIALS AND METHODS Sixty children (age 6-13 years) undergoing closed manipulation for fracture/dislocation around the elbow were randomly assigned to two groups, Group I (n=30) receiving brachial plexus block using Winnie's classical subclavian perivascular approach and Group II (n=30) receiving brachial plexus block using parascalene approach described by Dalens. Time required for performing the block, onset of analgesia, sensory block to pin prick, adequacy of relaxation, complications and acceptance of the technique to the children, parents and the surgeons were compared. RESULTS Time required for performing the block (6.3+/-2.2 min vs. 8.2+/-2.4 min), onset of subjective analgesia (4.1+/-1.6 min vs. 5.2+/-1.4 min) and onset of sensory block to pinprick (6.8+/-2.1 min vs. 8.6+/-1.7 min) were significantly shorter in Group I as compared to Group II (p<0.01). Acceptance of the techniques by the children, parents and the surgeons, and the overall success rates were high and comparable between the groups. Complications were minor and the incidence was low in both the groups except Horner's syndrome in 46.7% of patients in Group II. CONCLUSION Parascalene approach to brachial plexus block is comparable to classical subclavian perivascular approach in safety, success rate and acceptance in children undergoing closed manipulation and reduction of fracture/dislocation around the elbow.