Brachial plexus block with general anesthesia reduces opioid use and improves recovery in pediatric upper limb surgery

This retrospective propensity score matching cohort study compared two anesthetic approaches in 100 children (50 matched pairs) undergoing upper limb surgery. The intervention group received nerve stimulator-guided brachial plexus block supplemented with laryngeal mask general anesthesia, while the comparator received LMA general anesthesia alone. The primary outcomes measured were peripheral blood T lymphocyte subsets and inflammatory cytokines (TNF-α, IL-6, IL-10), with secondary outcomes including stress hormones, anesthetic drug dosage, recovery metrics, and pain scores.

Key results showed that the combined block and general anesthesia approach required less intraoperative remifentanil (P < 0.05), had shorter recovery times (P < 0.05), shorter extubation times (P < 0.05), and lower postoperative visual analog scale pain scores (P < 0.05) compared to general anesthesia alone. Measurements were taken at multiple time points from before anesthesia induction through 72 hours postoperatively. Specific effect sizes and absolute numbers for these outcomes were not reported in the available data.

Safety monitoring included postoperative adverse reactions as a secondary outcome, though specific adverse events, serious adverse events, discontinuation rates, and tolerability details were not reported. The study has several limitations: its retrospective observational design prevents establishing causality, key numerical data including effect sizes and absolute values were not provided, and details about funding, conflicts of interest, and specific adverse events were not reported. The findings suggest that combined regional and general anesthesia may offer advantages in pediatric upper limb surgery, but prospective randomized trials are needed to confirm these observations and establish clinical protocols.