Regional anaesthesia for awake urgent upper limb surgery in children: a prospective cohort study.
| Title: | Regional anaesthesia for awake urgent upper limb surgery in children: a prospective cohort study. |
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| Authors: | Maupain O; Department of Anaesthesiology, Claude Galien Private Hospital (Ramsay Générale de Santé), Quincy-sous-Sénart, France.; Delvaux B; Department of Anaesthesiology, Claude Galien Private Hospital (Ramsay Générale de Santé), Quincy-sous-Sénart, France.; Huynh D; Department of Anaesthesiology, Claude Galien Private Hospital (Ramsay Générale de Santé), Quincy-sous-Sénart, France.; Ehooman F; Department of Anaesthesiology, Claude Galien Private Hospital (Ramsay Générale de Santé), Quincy-sous-Sénart, France.; Zanoun N; Department of Anaesthesiology, Claude Galien Private Hospital (Ramsay Générale de Santé), Quincy-sous-Sénart, France.; Garnier T; Department of Anaesthesiology, Claude Galien Private Hospital (Ramsay Générale de Santé), Quincy-sous-Sénart, France.; Morel B; Department of Anaesthesiology, Claude Galien Private Hospital (Ramsay Générale de Santé), Quincy-sous-Sénart, France.; Franck C; Department of Anaesthesiology, Claude Galien Private Hospital (Ramsay Générale de Santé), Quincy-sous-Sénart, France.; Giral T; Department of Anaesthesiology, Claude Galien Private Hospital (Ramsay Générale de Santé), Quincy-sous-Sénart, France. |
| Source: | Anaesthesia [Anaesthesia] 2025 Sep; Vol. 80 (9), pp. 1065-1073. Date of Electronic Publication: 2025 Mar 11. |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: Wiley-Blackwell Country of Publication: England NLM ID: 0370524 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1365-2044 (Electronic) Linking ISSN: 00032409 NLM ISO Abbreviation: Anaesthesia Subsets: MEDLINE |
| Imprint Name(s): | Publication: Oxford, UK : Wiley-Blackwell; Original Publication: London, Academic Press; New York, Grune & Stratton. |
| MeSH Terms: | Upper Extremity*/surgery ; Anesthesia, Conduction*/methods ; Ambulatory Surgical Procedures*/methods; Anxiety/prevention & control ; Humans ; Child ; Male ; Female ; Prospective Studies ; Wakefulness ; Cohort Studies ; Anesthetics, Local ; Ultrasonography, Interventional ; Ropivacaine ; Anesthesia, General |
| Abstract: | Introduction: Peripheral regional anaesthesia is used rarely as the sole anaesthetic technique in children and is often combined with deep sedation or general anaesthesia for analgesic purposes. No literature addresses the minimum age at which regional anaesthesia can be considered to facilitate awake surgery in children. We hypothesised that children of school age could undergo awake urgent upper limb surgery with regional anaesthesia supported by anxiety-reduction strategies.; Methods: We recruited children aged 6-12 y who required urgent upper limb surgery. Peripheral regional anaesthesia with 0.35% ropivacaine was administered with ultrasound guidance and without neurostimulation. To reduce anxiety, patients watched cartoons on touchscreen tablets throughout the procedure. Sedatives or general anaesthesia were administered only if necessary. Anxiety was assessed during regional anaesthesia and surgery using the short form of the Modified Yale Pre-operative Anxiety Scale. Behavioural changes were evaluated on postoperative day 14 using the post-hospitalisation behaviour questionnaire.; Results: Of the 99 patients studied, 81 (82%) underwent successful awake surgery with peripheral regional anaesthesia. The success rate increased with age, from 12 (67%) in 6-year-olds to 10 (100%) in 12-year-olds. No serious adverse events or significant behavioural disturbances were observed at 2-week follow-up. The staff ratings showed low difficulty ratings in the regional anaesthesia alone group, apart from during catheter insertion in two patients. The administration of peripheral regional anaesthesia was rated to be difficult for six (41%) of the patients in the regional anaesthesia with sedation and/or general anaesthesia subgroup.; Discussion: Using regional anaesthesia to facilitate awake surgery is feasible in children of school age undergoing urgent upper limb surgery. Further investigations are needed to compare regional anaesthesia with general anaesthesia in this context.; (© 2025 The Author(s). Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists.) |
| References: | Anaesthesia. 2020 Jan;75 Suppl 1:e101-e110. (PMID: 31903582); BJA Educ. 2018 Feb;18(2):52-56. (PMID: 33456810); Ann Fr Anesth Reanim. 2012 Sep;31(9):e199-201. (PMID: 22920328); Br J Anaesth. 2017 Feb;118(2):247-253. (PMID: 28100529); Paediatr Anaesth. 2016 Apr;26(4):405-8. (PMID: 26857539); Curr Opin Anaesthesiol. 2017 Jun;30(3):362-367. (PMID: 28291127); Anesth Analg. 2014 Sep;119(3):643-650. (PMID: 25010821); Eur J Anaesthesiol. 2022 Jan 1;39(1):4-25. (PMID: 34857683); Am J Dis Child. 1966 Jun;111(6):581-93. (PMID: 5939538); Local Reg Anesth. 2018 Aug 08;11:35-44. (PMID: 30122981); Eur J Cancer. 2020 May;131:53-67. (PMID: 32302949); Child Care Health Dev. 2003 Jul;29(4):281-90. (PMID: 12823333); Anesth Analg. 2004 Dec;99(6):1648-1654. (PMID: 15562048); Br J Anaesth. 2020 Jul;125(1):104-109. (PMID: 32340734); J Pediatr Psychol. 2016 Mar;41(2):182-203. (PMID: 26476281); Anesth Analg. 1999 May;88(5):1069-72. (PMID: 10320170); BJA Educ. 2020 Oct;20(10):341-347. (PMID: 33456915); Reg Anesth Pain Med. 2016 Mar-Apr;41(2):181-94. (PMID: 26695878); Paediatr Anaesth. 2022 Dec;32(12):1292-1304. (PMID: 35993398); Anesth Analg. 2009 Sep;109(3):737-44. (PMID: 19690240); Best Pract Res Clin Anaesthesiol. 2019 Dec;33(4):499-505. (PMID: 31791566); BJA Educ. 2019 Oct;19(10):342-348. (PMID: 33456856); Paediatr Anaesth. 2010 Dec;20(12):1061-9. (PMID: 21199114); Br J Anaesth. 2017 Mar 1;118(3):335-343. (PMID: 28203739); Anesthesiology. 2018 Oct;129(4):721-732. (PMID: 30074928) |
| Grant Information: | Ramsay Santeacute |
| Contributed Indexing: | Keywords: axillary block; distraction techniques; paediatric anaesthesia; regional anaesthesia; upper limb surgery |
| Substance Nomenclature: | 0 (Anesthetics, Local); 7IO5LYA57N (Ropivacaine) |
| Entry Date(s): | Date Created: 20250311 Date Completed: 20250825 Latest Revision: 20250825 |
| Update Code: | 20260130 |
| PubMed Central ID: | PMC12351207 |
| DOI: | 10.1111/anae.16594 |
| PMID: | 40069122 |
| Database: | MEDLINE |
Journal Article