Coracoid Block in Pediatrics: A Case Report of a 9-Month-Old Infant

Abstract

Introduction

Ultrasound-guided regional anesthesia has expanded perioperative management options in pediatric patients. The coracoid block, a variant of the infraclavicular brachial plexus approach, provides adequate anesthetic coverage for upper-extremity surgery; however, its use in infants remains scarcely reported. We present the case of a 9-month-old infant successfully managed using this technique.

Objective

To describe the use of an ultrasound-guided coracoid block in a 9-month-old infant and highlight its utility as an alternative regional anesthesia technique for upper-extremity surgery.

Case Description

A 9-month-old male infant with congenital syndactyly of the third and fourth digits of the right hand was scheduled for surgical release. Relevant medical history included birth at 37 weeks of gestation, requiring respiratory support and phototherapy during the neonatal period, with no subsequent sequelae. No significant comorbidities were identified during the preanesthetic evaluation.

Laboratory findings were as follows: glucose 90.4 mg/dL, urea 10.3 mg/dL, BUN 4.8 mg/dL, creatinine 0.22 mg/dL, hemoglobin 12.2 g/dL, hematocrit 38.2%, platelet count 475,000/mm³, leukocyte count 9.2 × 10³/mm³, blood group O positive, PT 10.4 seconds, INR 0.97, and aPTT 31.4 seconds.

Anesthetic Management

Inhalational induction was performed with sevoflurane while maintaining spontaneous ventilation to facilitate peripheral venous cannulation. Subsequently, under ultrasound guidance and sterile conditions, a right coracoid brachial plexus block was performed using a mixture of 2.5 mL of 0.75% ropivacaine and 1.5 mL of 1% lidocaine, for a total volume of 4 mL.

After completion of the block, sevoflurane was discontinued, and anesthesia was maintained with propofol infusion at 30–60 μg/kg/min, dexmedetomidine at 0.3–0.5 μg/kg/h, and fractionated fentanyl doses totaling 40 μg to maintain an adequate anesthetic depth.

Results

The technique provided satisfactory surgical conditions throughout the procedure. Hemodynamic parameters remained stable during the intraoperative period, and no block-related complications were observed. In the immediate postoperative period, the patient had a FLACC score of 3, indicating adequate analgesic control.

Discussion

Ultrasound-guided regional anesthesia has gained increasing importance in pediatric practice because of its ability to optimize perioperative pain management while reducing exposure to systemic anesthetic agents. Although no neurocognitive impairment has been demonstrated following a single brief exposure to general anesthesia, recent evidence suggests that multiple exposures before five years of age may be associated with less favorable neurodevelopmental outcomes. In this context, regional anesthesia techniques provide satisfactory anesthetic conditions and effective perioperative analgesia.

Conclusion

Ultrasound-guided coracoid block proved to be a feasible and safe technique in a 9-month-old infant, providing satisfactory perioperative anesthetic and analgesic conditions without associated complications or significant adverse events.