The motor effects of 0.25% bupivacaine vs 0.19 bupivacaine in ultrasound-guided axillary brachial plexus block in pediatrics undergoing below-elbow orthopedic surgeries: A randomized controlled study

Figures & data

Figure 1. Sonoanatomy of axillary brachial plexus.

Figure 2. Probe position in the axilla.

Table 1. FLACC pain scale.

Categories	0	1	2
Face	No particular expression or smile	Occasional grimace or frown; withdrawn, disinterested	Frequent to constant frown, clenched jaw, quivering chin
Legs	Normal position or relaxed	Uneasy, restless, tense	Kicking or legs drawn up
Activity	Lying quietly, normal position, moves easily	Squirming, shifting back and forth, tense	Arched, rigid, or jerking
Cry	No cry (awake or asleep)	Moans or whimpers, occasional complaint	Crying steadily, screams or sobs; frequent complaints
Consolability	Content, relaxed	Reassured by occasional touching, hugging, or being talked to; distractible	Difficult to console or comfort
Each category is scored on the 0–2 scale, which results in a total score of 0–10. 0: Relaxed and comfortable 1–3: Mild discomfort 4–6: Moderate pain 7–10: Severe discomfort or pain or both

Figure 3. CONSORT flowchart of the studied patients.

Table 2. Patients demographic data in group (A) and group (B) (n = 60).

		Group A (n = 30)	Group B (n = 30)	P value
Age (years)		6.87 ± 2.52	6.00 ± 2.17	0.158
Weight (kg)		23.30 ± 7.35	23.47 ± 7.30	0.930
Sex	Female	17 (56.7%)	14 (46.7%)	0.438
	Male	13 (43.3%)	16 (53.3%)

Data are expressed as mean ± standard deviation (Group A): 0.25% bupivacaine (Group B): 0.19% bupivacaine.

Table 3. Modified Bromage scale in group (A) and group (B) (n = 60).

	Group A (n = 30)	Group B (n = 30)	P value
Bromage (0)	2 (1, 2)	3 (2, 3)	<.001*
Bromage (30)	2 (2, 3)	3 (3, 3)	<.001*
Bromage (60)	3 (3, 3)	4 (3, 4)	<.001*
Bromage (90)	4 (3, 4)	4 (4, 4)	.104
Bromage (120)	4 (4, 4)	4 (4, 4)	1
Bromage (150)	4 (4, 4)	4 (4, 4)	1
Bromage (180)	4 (4, 4)	4 (4, 4)	1

Data are presented as median (IQR), *significant as P value < 0.05. Bromage: at time of admission to PACU, Bromage 0: after 30 min from admission to PACU, Bromage 60: after 60 min, Bromage 90: after 90 min, Bromage 120: after 120 min, Bromage 150: after 150 min, Bromage 180: after 180 min.

Table 4. FLACC score in group (A) and group (B) (n = 60).

	Group A (n = 30)	Group B (n = 30)	P value
FLACC O.	0 (0,0)	0 (0,0)	.317
FLACC 1st h	0 (0,0)	0 (0,0)	.317
FLACC 4th h	0 (0,0)	0 (0,1)	.015*
FLACC 8th h	0 (0,1)	1 (0,2)	.010*
FLACC 12th h	0 (0,1)	.5 (0,2)	.099

Data are presented as median (IQR), *significant as P value < 0.05. FLACC: Face, Legs, Activity, Cry, and Consolability scale. FLACC0: at recovery, FLACC 1st hour: after 1 h postoperative, FLACC 4th hour: after 4 h postoperative, FLACC 8th hour: after 8 h postoperative, FLACC 12th hour: after 12 h postoperative.

Figure 4. Intraoperative heart rate. HR0 = at time of admission to OR, HR1 = after induction, HR2 = after skin incision, HR15 = after 15 min. HR30 = after 30 min from skin incision, HR45 = after 45 minfrom skin incision, HR60 = after 60 min from skin incision.

Figure 5. Intraoperative mean arterial blood pressure, MAP. MAP0 = at time of admission to OR, MAP1 = after induction, MAP2 = after skin incision, MAP15 = after 15 min. MAP30 = after 30 minutes from skin incision, MAP45 = after 45 min from skin incision, MAP60 = after 60 min from skin incision.