Efficacy of ultrasound with or without nerve stimulator for infraclavicular brachial plexus block in children undergoing elective upper extremity orthopedic surgery

Ultrasound with nerve stimulator for infraclavicular brachial plexus block in children undergoing elective upper extremity orthopedic surgery, intervention arm is the injured arm and did not apply anything to healty arm Lateral sagittal infraclavicular brachial plexus block with neurostimulator was applied to injured arm at a dose of 0.5 mg per kg levobupivacaine after general anesthesia induction and before surgery starts. The stimulator was initially adjusted to the parameters of 1.0 mA, 2 Hz, 0.1 ms. The insertion was performed with the sagittal plane in an anteroposterior manner at a 30–45 degrees angle from the intervention point to the ground where the patient was lying. When twitching response was obtained from one of the nerves , the current was reduced to 0.5 mA and this was considered to be an indicator of successful localization of nerve. To perform the ultrasound for the nerve block, a General Electric (GE) LOGIQ e model Linear Multifrequency 12L probe (GE Medical Systems, Phoenix-USA) was used. Multistimpleks (Pajunk, Germany) was used as nerve stimulator, and a custom needle specific to plexus anesthesia, Stimupleks A (B. Braun Melsungen AG, Japan) 21G, 50 mm was used as the needle. The USG probe was placed in the sagittal plane 1 cm under the conjunction of the clavicle and coracoid process. After the axillary artery and cords were identified, the stimulation needle was advanced (with the in-plane technique) to be in the same plane as the USG probe.