Our Ultrasound Guided Brachial Plexus Block Experiences for Upper Extremity Surgeries in Pediatric Patients.

OBJECTIVES: Brachial plexus block is the most effective analgesia and anesthesia procedure for the upper extremity surgeries in pediatric patients. In recent years, ultrasound guidance for this procedure has reduced the fail and complications like pneumothorax, intravascular injection and nerve damage. However, the number of studies about brachial plexus block is not enough, particularly in pediatric patients, which remained under-researched. In our study, we aimed to discuss the efficacy and safety of the ultrasound-guided brachial plexus block in pediatric patients by retrospectively examining their data. METHODS: We retrospectively reviewed the data of pediatric patients who underwent ultrasound-guided brachial block in our clinic between January 2015-January 2017. Demographic data, diagnosis, procedure and operation times, medications, motor and sensorial block times were recorded. RESULTS: Between January 2015 and January 2017, the number of pediatric patients who underwent ultrasound-guided peripheral nerve block in our clinic was 24. In 15 of these patients, the supraclavicular block was applied in 15, and the infraclavicular block was applied in nine patients. The mean age of the patients was 9.6±3.12, with a male/female ratio 14/10. The mean duration of the procedure was 9.54±2.14 minutes in patients for the supraclavicular block and 12.9 ± 2.8 minutes for the infraclavicular block. The mean surgery time was 64±13.6 minutes. As a local anesthetic, bupivacaine was used in three patients; bupivacaine+lidocaine combination was used in 21 patients and adjuvants were added in eight patients. The block procedure was performed under general anesthesia in 12 patients and under sedation in 12 patients. The mean motor block time was 7.5±2 hours in patients who received supraclavicular block, and 7.4±1.5 hours in patients who received infraclavicular block. The mean sensorial block time was 10.5±1.7 hours in the supraclavicular block, and 10.45±1.15 hours in the infraclavicular block. The mean motor block period with added adjuvants was 7.7±0.5 hours, and the sensorial block period was 11.12±1.1 hours. No complications were seen during the procedure, intraoperative and postoperative follow-up. CONCLUSION: Ultrasound-guided brachial plexus block in pediatric patients is effective and safe, with longer analgesia duration and lower complication rates. Prospective studies with a larger number of patients are needed in this regard.

The safety and the efficacy of computed tomography guided percutaneous radiofrequency ablation of osteoid osteoma.

OBJECTIVE: The aim of this study was to investigate the efficacy and safety of Computed Tomography (CT) guided percutaneous Radiofrequency Ablation (RFA) in the treatment of osteoid osteoma (OO). METHODS: A total of 116 patients (82 male and 34 female patients; mean age of 17.7 years; age range 13-months-42 years) who had 118 CT guided RFA treatment between June 2015 and November 2018 (42 moths) with the diagnosis of OO were included in this study. All the patients had pre-procedural CT examinations. The clinical and technical success and the safety of the treatment were evaluated by assessing the clinical pain symptoms, complication rates and recovery of posture and gait. RESULTS: All the patients had a favorable immediate relief of the known pain caused by osteoid osteoma in 24 h after the procedure. Only in two patients (15-years-old boy with OO in right femoral neck and a 12 years old boy with OO in femur diaphysis) pain relapse was occurred in 3 months and 12 months after RFA and a second RFA was performed. During follow-up they had no pain. The technical success and efficacy-rates of the procedure were recorded as 100% and 98% respectively in this study. No significant complication was observed during treatment or recovery period. Seven minor complications were noted which were successfully treated. CONCLUSION: The rapid relief of pain symptoms, low relapse rate and low complication rates demonstrate the efficacy and safety of RFA therapy. RFA is an out-patient procedure that patients can be mobilized immediately after the procedure. RFA can be safely used as a first choice of treatment method in OO therapy. LEVEL OF EVIDENCE: Level IV, therapeutic study.

Successful percutaneous treatment of osteoid osteoma in a 13 month-old boy with radiofrequency ablation under CT guidance.

We present a 13-month-old boy who had a successful Computed Tomography (CT) guided percutaneous radiofrequency ablation (RFA) treatment for the osteoid osteoma (OO) on proximal part of the tibial diaphysis. The complaints of the patient were being restless due to pain and refusing to bear any weight on his left leg for 6 months. An asymmetrical cortical thickening and a focal sclerosis was detected on medial proximal diaphysis of the left tibia on radiographs and axial T2-weighted STIR-MR image showed bone marrow and soft-tissue edema with low-signal-intensity nidus due to central calcification with a high-signal-intensified unmineralized periphery. CT findings (the nidus on the cortex of tibia with well circumscribed lucent region around a central sclerotic dot and cortical thickening around the nidus) confirmed the diagnosis of OO. After CT guided percutaneous RFA treatment, the patient had an immediate pain relief in 24 h after and could bear weight on the leg. 12 and 16 months after RFA respectively, CT images and radiographs revealed sclerotic healing of the nidus and a slow regression of the adjacent cortical thickness without any recurrence.

Effects of topical alkane vapocoolant spray on pain intensity prior to digital nerve block for ingrown nail surgery.

Needle penetration and local anesthetic infiltration are 2 painful steps that cause considerable stress and anxiety during digital nerve block, which is the most frequently used regional anesthesia for ingrown nail surgery. The purpose of this study was to evaluate the effectiveness of topical alkane vapocoolant spray in decreasing pain during digital nerve block for ingrown nail surgery. The authors conducted a prospective, randomized clinical trial with 62 patients who underwent big toenail surgery. Prior to the digital block, alkane vapocoolant spray was applied to patients who were selected by flipping a coin. A visual analog scale (VAS) was used for assessment of pain during the skin needle penetration and during the infiltration of the anesthetic product. VAS scores during needle penetration were significantly lower in the intervention group. However, VAS scores during infiltration were similar statistically. Alkane vapocoolant spray has no noticeable clinical benefit in decreasing pain intensity during digital nerve block in patients undergoing toenail surgery.