Abstract

PEREZ-PRADILLA, Andrea Carolina et al. Infraclavicular block in paediatric anaesthesia: Concordance between the modified Wilson approach and ultrasound in determining the ideal puncture site. Rev. colomb. anestesiol. [online]. 2015, vol.43, n.4, pp.269-277. ISSN 0120-3347.

Introduction: The modified Wilson infraclavicular approach (MWIA) was described in our institution for brachial plexus blocks in paediatric patients. However, concordance studies between this approach and ultrasound for the identification of ideal puncture site have no been reported. Objective: To determine the concordance between MWIA and ultrasound for localization of the ideal puncture site. Materials and methods: Descriptive observational study; we included 100 healthy patients between 1 and 16 years of age, with parental consent, over a 5-month period. Continuous variables were described and kappa statistics were used for concordance evaluation. We also conducted a multivariate analysis to confirm the relationship between the measured distances and weight and height. Results: The distance fromthe skin to the brachial plexus, aswell as the distance between the coracoid process and the brachial plexus, and the distance from the coracoid process to the pleura were all smaller in abduction, with no statistically significant difference. Height and weight are independent factors that determine the distance between the coracoid process and the posterior cord, both in adduction and abduction. The concordance of MWIA vs. ultrasound for determining the ideal puncture site was 47% in both positions. Conclusions: Concordance between MWIA and ultrasound for the determination of the ideal puncture site is low when it comes to anatomic localization; however, this technique must be evaluated in randomized clinical studies in order to determine its efficacy and usefulness. Height and weight are independent factors that determine the distance between the coracoid process and the posterior cord in adduction and abduction.

Keywords : Anesthesia; Conduction ultrasonography; Brachial plexus; Pediatrics; Nerve block.

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