Background Pediatric surgical trauma can trigger the body's stress response, leading to immune dysfunction and affecting postoperative recovery. At present, nerve stimulator-guided brachial plexus block has been widely used in children, but its effect on immune function combined with laryngeal mask general anesthesia remains to be clarified. Aim This study assessed the impact of combined brachial plexus block and general anesthesia on inflammatory, stress, and immune responses in children undergoing upper limb surgery. Methods This retrospective propensity score matching (PSM) cohort study analyzed children undergoing upper limb surgery (June 2022-June 2024). Participants were stratified according to the anesthesia technique used during their upper limb surgery: the observation group received nerve stimulator-guided brachial plexus block, supplemented with laryngeal mask (LMA) general anesthesia, while controls received LMA general anesthesia alone. The primary outcome was the peripheral blood T lymphocyte subsets (CD3 + , CD4 + , CD8 + , CD4 + /CD8 + ) and inflammatory cytokines (TNF-α, IL-6, IL-10) measured before anesthesia induction (T0), at the end of surgery (T1), and at 6 h (T2), 24 h (T3), and 72 h (T4) postoperatively. Secondary outcomes included stress hormone levels cortisol [COR, epinephrine E, norepinephrine NE], anesthetic drug dosage, recovery time, extubation time, visual analog scale (VAS) scores, and postoperative adverse reactions. Results 1:1 PSM yielded 50 matched pairs with balanced baseline characteristics (all P 0.05). The observation group required less intraoperative remifentanil, had shorter recovery and extubation times, and exhibited lower VAS scores at all postoperative time points (all P 0.05). Immunological analyses revealed that the observation group maintained higher CD3 + and CD4 + cell percentages, along with an elevated CD4 + /CD8 + ratio at T1-T4 timepoints ( P 0.05), whereas CD8 + cell levels were significantly lower at T2 ( P 0.05). Furthermore, the observation group exhibited attenuated inflammatory and stress responses, with lower concentrations of TNF-α, IL-6, cortisol, epinephrine, and norepinephrine at T1-T3, and lower levels of the anti-inflammatory IL-10 at T2 ( P 0.05). The overall incidence of postoperative nausea, vomiting, and restlessness was also significantly reduced in the observation group ( P 0.05). Conclusion Nerve stimulator-assisted brachial plexus block and LMA general anesthesia provides immunoprotection in children, enabling lower drug consumption, faster recovery, and fewer complications, thus proving clinically valuable.
Pang et al. (Wed,) studied this question.