Revista de la Sociedad Española del Dolor
versión impresa ISSN 1134-8046
One of the best methods to manage and control intra- and postoperative pain is regional anesthesia. In pediatric patients, this type of analgesia is normally applied with general anesthesia or deep sedation, due to poor or absent patient cooperation. For shoulder and arm surgery, because of the frequency of related complications such as ipsilateral phrenic paralysis, among other complications, one of the most effective peripheral blocks is the interscalenic brachial plexus block. We report the case of a 13-year-old boy who was a candidate for a cadaveric humerus graft in the right forelimb. Tumor resection had been performed 1 year previously with poor pain control with morphine using a patient-controlled analgesia delivery system. The anesthetic technique consisted of general anesthesia followed by interscalenic brachial plexus block with ultrasound-guidance and neurostimulation and subsequent catheter placement for postoperative analgesia. During the 6-hour intervention, 10 ml of levobupivacaine 0.5% was administered with no need for additional analgesics. After surgery, the patient was extubated in the operating room. The absence of pain, Horner syndrome and left diaphragmatic paralysis without clinical repercussions were noted. During the next 24 hours, 10 ml/h of ropivacaine 0.25% was administered via catheter, achieving excellent analgesia without the need for local anesthetic bolus on demand. In conclusion, regional anesthesia contributes to correct intra- and postoperative analgesia and reduces the need for additional analgesics. Ultrasound guidance in interscalenic block allows direct visualizations of the administration area and lowers the local anesthetic doses required, which may reduce complications in this kind of plexus.
Palabras clave : Interscalenic block; Pediatrics; Regional anesthesia; Ultrasound-guided; Interscalenic block.