Upper Arm Block Anesthesia in Children With Fractures

Regional block anesthesia is especially useful for fractures of the arm in children. The technique here recommended involves an axillary route instead of the supraclavicular route. When the injection is made the proximal part of the humerus is used as a "backstop," and the terminal portion of the axillary artery serves as a constant and convenient landmark; the median and musculocutaneous nerves lie anterolateral to the artery, while the ulnar and radial nerves lie respectively anterior and posterolateral to it. Using this site for the injection eliminates the danger of pneumothorax, and by producing a sympathetic blockade it improves circulation in the arm. The present series of 80 patients with fractures included 72 children 10 years of age or under. Premedication consisted of pentobarbital given intramuscularly. The anesthetic used was lidocaine (Xylocaine) hydrochloride in 1.5% concentration with epinephrine 1:100,000, and the average volume injected was 10 cc. With the moderate sedation used and the reassurance of freedom from pain, the overwhelming majority of the patients have been extremely cooperative.