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Objective: To observe the anesthetic effect and safety of different doses of dexmedetomidine combined with ropivacaine for brachial plexus nerve block in children undergoing polydactyly surgery., Methods: Eighty children undergoing polydactyly surgery were randomized into 4 groups to receive brachial plexus nerve block with dexmedetomidine at 0.25, 0.50 or 0.75 µg/kg combined with 0.25% ropivacaine (0.20 mL/kg) (D1, D2, and D3 groups, respectively) or with 0.25% ropivacaine (0.20 mL/kg) only (control group). The onset time, duration of brachial plexus nerve block, awakening time, success rate, and incidence of complications were compared among the groups. Results In D2 and D3 groups, the onset time and awakening time were shorter and anesthesia lasted longer than those in the control group. The onset time and awakening time were shorter and anesthesia maintenance time was longer in D3 group than in D1 group. The success rates of brachial plexus nerve block were significantly higher in D1-3 groups than in the control group (P<0.05). Hematoma was found in one of the patients. In each of the 4 groups, laryngeal nerve block occurred in 1 child and respiratory depression in another; 2 or 3 patients had Horner syndrome, and 1 patient in D3 group experienced an episode of lowered heart beat to below 70 min -1 . All the complications were managed properly and the patients all recovered uneventfully., Conclusion: Brachial plexus nerve block with 0.5 µg/kg dexmedetomidine combined with 0.25% ropivacaine (0.20 mL/kg) is safe for effective anesthesia in children undergoing surgery for polydactyly.

Objective: To assess whether the enhanced imaging technology can improve the needle visibility during ultrasound-guided auxillary brachial plexus block., Methods: After obtaining informed consent, 60 ASA (American Society of Anesthesiologists) I-II patients undergoing forearm or hand surgery were enrolled in this prospective, randomized, double-blind study. The patients were randomly assigned to two groups, the common image group (n=30) and enhanced image group (n=30). Ultrasound was used in guiding the block of the four branches of brachial plexus, i.e. the median, radial, ulnar and musculocutaneous nerves. In the enhanced image group a special function key "Multi-beam enhance" (MBe) was turned on during the needle insertion. After the nerve stimulator identification of the median, radial, ulnar and musculocutaneous nerves, 10 mL of 0.5% ropivacaine was injected near each nerve. The operating time, the visibility of the needle, the depth of each nerve, the onset time of the block, and the complications related to the block were assessed and recorded., Results: The operating time was significantly shorter in the enhanced image group compared with the common image group [(2.63±0.81) min vs. (5.07±1.89) min, P=0.01]. The visibility of the needle was better in enhanced image group when the radial and musculocutaneous nerve blocks were performed (P<0.05)., Conclusion: The enhanced image technology can reduce the operating time and improve the visibility of the needle during the peripheral nerve block for the nerve which is relatively deep.

Objective: To investigate the optimal dose of local anesthetic mixture in ultrasound-guided infraclavicular brachial plexus block via coracoid approach., Methods: 160 patients scheduled for surgery of the hand or forearm were randomly divided into 4 equal groups (Groups A, B, C, and D). To receive 8, 7, 6, or 5 ml of anesthetic mixture of 0.75% ropivacaine and 2% lidocaine for radial nerve, axillary nerve, median nerve, ulnar nerve, median cutaneous nerve of arm, median antebrachial cutaneous nerve, and lateral antebrachial cutaneous nerve respectively ultrasound-guided infraclavicular brachial plexus block via coracoid approach. The time for anesthesia taking effect, anesthesia maintenance time, and quality of sensory block were observed., Results: Anesthesia took effect about 4 minutes after injection in these 4 groups without significant differences among then (all P > 0.05). The good analgesic effect rates of Groups A, B, and C were all 100%, all significantly higher than that of Group D (87.5%, P = 0.027). The block maintenance times of Groups A, B, and C were (377 +/- 111) min, (369 +/- 135) min, and (351 +/- 112) min respectively, all significantly longer than that of Group D [(296 +/- 101) min, P = 0.024]. No anesthesia-related complication was found in these 4 groups., Conclusion: Ultrasound-guided infraclavicular brachial plexus block via coracoid approach can reduce the volume of local anesthetic mixture. The dose of 6 ml local anesthetic mixture for each nerve fascicle, totally 18 ml, provides good analgesic effect and does not seem to affect the time for anesthesia taking effect.