Frontiers in pediatrics · 2026
Immunomodulatory effects of nerve stimulator-guided brachial plexus block with laryngeal mask general anesthesia in pediatric upper limb surgery.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Pang Peng, Kang Shufeng, Wang Qiujun, Zhao Longbiao, Wang Jincheng, Kang Rongtian, Wu Xiaoning, Zhang Chunying, Hao Lijing
Аннотация
BACKGROUND: Pediatric surgical trauma can trigger the body's stress response, leading to immune dysfunction and affecting postoperative recovery. At present, nerve stimulator-guided brachial plexus block has been widely used in children, but its effect on immune function combined with laryngeal mask general anesthesia remains to be clarified.
AIM: This study assessed the impact of combined brachial plexus block and general anesthesia on inflammatory, stress, and immune responses in children undergoing upper limb surgery.
METHODS: This retrospective propensity score matching (PSM) cohort study analyzed children undergoing upper limb surgery (June 2022-June 2024). Participants were stratified according to the anesthesia technique used during their upper limb surgery: the observation group received nerve stimulator-guided brachial plexus block, supplemented with laryngeal mask (LMA) general anesthesia, while controls received LMA general anesthesia alone. The primary outcome was the peripheral blood T lymphocyte subsets (CD3+, CD4+, CD8+, CD4+/CD8+) and inflammatory cytokines (TNF-α, IL-6, IL-10) measured before anesthesia induction (T0), at the end of surgery (T1), and at 6 h (T2), 24 h (T3), and 72 h (T4) postoperatively. Secondary outcomes included stress hormone levels [cortisol [COR], epinephrine [E], norepinephrine [NE]], anesthetic drug dosage, recovery time, extubation time, visual analog scale (VAS) scores, and postoperative adverse reactions.
RESULTS: 1:1 PSM yielded 50 matched pairs with balanced baseline characteristics (all P > 0.05). The observation group required less intraoperative remifentanil, had shorter recovery and extubation times, and exhibited lower VAS scores at all postoperative time points (all P < 0.05). Immunological analyses revealed that the observation group maintained higher CD3+ and CD4+ cell percentages, along with an elevated CD4+/CD8+ ratio at T1-T4 timepoints (P < 0.05), whereas CD8+ cell levels were significantly lower at T2 (P < 0.05). Furthermore, the observation group exhibited attenuated inflammatory and stress responses, with lower concentrations of TNF-α, IL-6, cortisol, epinephrine, and norepinephrine at T1-T3, and lower levels of the anti-inflammatory IL-10 at T2 (P < 0.05). The overall incidence of postoperative nausea, vomiting, and restlessness was also significantly reduced in the observation group (P < 0.05).
CONCLUSION: Nerve stimulator-assisted brachial plexus block and LMA general anesthesia provides immunoprotection in children, enabling lower drug consumption, faster recovery, and fewer complications, thus proving clinically valuable.
AIM: This study assessed the impact of combined brachial plexus block and general anesthesia on inflammatory, stress, and immune responses in children undergoing upper limb surgery.
METHODS: This retrospective propensity score matching (PSM) cohort study analyzed children undergoing upper limb surgery (June 2022-June 2024). Participants were stratified according to the anesthesia technique used during their upper limb surgery: the observation group received nerve stimulator-guided brachial plexus block, supplemented with laryngeal mask (LMA) general anesthesia, while controls received LMA general anesthesia alone. The primary outcome was the peripheral blood T lymphocyte subsets (CD3+, CD4+, CD8+, CD4+/CD8+) and inflammatory cytokines (TNF-α, IL-6, IL-10) measured before anesthesia induction (T0), at the end of surgery (T1), and at 6 h (T2), 24 h (T3), and 72 h (T4) postoperatively. Secondary outcomes included stress hormone levels [cortisol [COR], epinephrine [E], norepinephrine [NE]], anesthetic drug dosage, recovery time, extubation time, visual analog scale (VAS) scores, and postoperative adverse reactions.
RESULTS: 1:1 PSM yielded 50 matched pairs with balanced baseline characteristics (all P > 0.05). The observation group required less intraoperative remifentanil, had shorter recovery and extubation times, and exhibited lower VAS scores at all postoperative time points (all P < 0.05). Immunological analyses revealed that the observation group maintained higher CD3+ and CD4+ cell percentages, along with an elevated CD4+/CD8+ ratio at T1-T4 timepoints (P < 0.05), whereas CD8+ cell levels were significantly lower at T2 (P < 0.05). Furthermore, the observation group exhibited attenuated inflammatory and stress responses, with lower concentrations of TNF-α, IL-6, cortisol, epinephrine, and norepinephrine at T1-T3, and lower levels of the anti-inflammatory IL-10 at T2 (P < 0.05). The overall incidence of postoperative nausea, vomiting, and restlessness was also significantly reduced in the observation group (P < 0.05).
CONCLUSION: Nerve stimulator-assisted brachial plexus block and LMA general anesthesia provides immunoprotection in children, enabling lower drug consumption, faster recovery, and fewer complications, thus proving clinically valuable.