Letters to the Editor: Letters & Announcements
To the Editor:
The advantages of infraclavicular brachial plexus block (ICB) were first described by Tissot et al. (1) in children, and since then several descriptions have been published (2,3). Dadure et al. (4) first reported the feasibility and efficacy of a continuous ICB in postoperative pain in children. We have been confronted with the case of an 11-year-old traumatized patient who was jeopardized in a traffic accident in which his hand was injured. He was subjected to several orthopedic surgeries, iterative care, and hyperbaric oxygen therapy for the anaerobic bacterial infection. A few days after his arrival, he became agitated and aggressive. With the advice of a pedo-psychiatrist, clonazepam was administered as a way to calm the child, but it was not totally effective. Thus, we decided to perform continuous ICB (Fig. 1) to allow more comfort to the child and to avoid iterative general anesthesia. Continuous ICB broke the vicious circle consisting of pain, agitation, anxiety, aggressiveness, and fear, without any adverse effects or complications, and permitted the discontinuation of all sedatives or analgesics, avoiding side effects. Thus we confirm the use of continuous ICB for pain management of the upper limb in children.
Vincent Minville, MD
Clément Chassery, MD
Delphine Kern, MD
Olivier Fourcade, MD, PhD
Department of Anesthesiology and Intensive Care
Toulouse University Hospital
Christophe Dadure, MD
Department of Anesthesiology and Intensive Care; Montpellier University Hospital; Montpellier, France
1. Tissot M, Lassauge F, Arbez-Gindre F, et al. Brachial plexus block by infraclavicular approach in children: value of a nerve stimulator? Apropos of 20 cases. Agressologie 1991;32:86–7.
2. Fleischmann E, Marhofer P, Greher M, et al. Brachial plexus anaesthesia in children: lateral infraclavicular vs axillary approach. Paediatr Anaesth 2003;13:103–8.
3. Zimmermann P, Papenfuss T, Schwemmer U, et al. Vertical infraclavicular brachial plexus block in a child with cystic fibrosis. Anesth Analg 2002;95:1825–6.
4. Dadure C, Raux O, Troncin R, et al. Continuous infraclavicular brachial plexus block for acute pain management in children. Anesth Analg 2003;97:691–3.