Patient Selection for Locoregional Anesthesia in Pediatric Hand and Upper-Extremity Surgery: The Role of Age, Child Anxiety, and Parental Anxiety

Öz

Aim/Objective: The aim of this study was to identify the clinical and anxiety characteristics associated with the selection of locoregional versus general anesthesia in children undergoing hand and upper-extremity surgery. We hypothesized that older age, lower preoperative child anxiety, and lower parental anxiety would be associated with selection for locoregional anesthesia. Methods: This study was designed as a retrospective cohort study. A total of 101 pediatric patients who underwent hand and upper-extremity surgery at a single center between 2005 and 2019 were included and categorized into three age groups (3–7, 7–11, and 11–15 years). Anesthetic technique (locoregional, n=51; general, n=50) was selected according to routine clinical practice. Child anxiety was assessed with the modified Yale Preoperative Anxiety Scale (mYPAS) and parental anxiety with the State-Trait Anxiety Inventory-State form (STAI-1) preoperatively, immediately postoperatively, and on postoperative day 10. Groups were compared using the independent-samples t-test, Mann-Whitney U test, and chi-square test. Results: The proportion of patients managed under locoregional anesthesia increased with age: 33.3% in the 3–7-year, 50.0% in the 7–11-year, and 67.7% in the 11–15-year group (p=0.027). Preoperative mYPAS scores (13.2±1.4 vs. 17.4±1.2) and parental STAI-1 scores (50.3±5.4 vs. 60.9±6.4) were lower in the locoregional group (both p<0.001), consistently across all age strata. Mean operative duration was shorter in the locoregional group (47.5±25.4 vs. 58.8±27.8 min; p=0.036), a difference driven by the 3–7-year group. One additional patient planned for locoregional anesthesia required conversion to general anesthesia because of unexpectedly prolonged surgery. Conclusions: In light of these findings, it was concluded that locoregional anesthesia is feasible in selected children undergoing hand and upper-extremity surgery, particularly older children with low child and parental anxiety undergoing procedures of short expected duration. Realistic estimation of operative time is essential before choosing this technique. Prospective studies with multivariable analysis are needed to define objective selection criteria.

Anahtar Kelimeler

• Anesthesia
• Conduction
• Anxiety
• Parents
• Patient Selection
• Hand/surgery

Etik Beyan

This study was approved by the Istanbul Nisantasi University Health Sciences Ethics Committee (decision no: SBETKK2025-01, dated January 6, 2025). It was conducted in accordance with the principles of the Declaration of Helsinki. Written informed consent was obtained from the parents or legal guardians of all participants. Patient data were anonymized before analysis, and confidentiality was maintained throughout the study.

Pediatrik El ve Üst Ekstremite Cerrahisinde Lokorejyonel Anestezi için Hasta Seçimi: Yaş, Çocuk Anksiyetesi ve Ebeveyn Anksiyetesinin Rolü

Öz

Amaç: Bu çalışmanın amacı, el ve üst ekstremite cerrahisi uygulanan çocuklarda lokorejyonel veya genel anestezi seçimiyle ilişkili klinik ve anksiyete özelliklerini belirlemektir. İleri yaşın, düşük preoperatif çocuk anksiyetesinin ve düşük ebeveyn anksiyetesinin lokorejyonel anestezi seçimiyle ilişkili olacağı hipotez edilmiştir. Yöntem: Bu çalışma retrospektif kohort çalışması olarak tasarlanmıştır. 2005–2019 yılları arasında tek merkezde el ve üst ekstremite cerrahisi uygulanan 101 pediatrik hasta çalışmaya dahil edilmiş ve üç yaş grubuna (3–7, 7–11 ve 11–15 yaş) ayrılmıştır. Anestezi yöntemi (lokorejyonel, n=51; genel, n=50) rutin klinik uygulamaya göre belirlenmiştir. Çocuk anksiyetesi modifiye Yale Preoperatif Anksiyete Ölçeği (mYPAS), ebeveyn anksiyetesi ise Durumluk-Sürekli Kaygı Envanteri-Durumluk Formu (STAI-1) ile preoperatif dönemde, ameliyat sonrası erken dönemde ve postoperatif 10. günde değerlendirilmiştir. Gruplar bağımsız örneklem t-testi, Mann-Whitney U testi ve ki-kare testi ile karşılaştırılmıştır. Bulgular: Lokorejyonel anestezi uygulanan hastaların oranı yaşla birlikte artmıştır: 3–7 yaş grubunda %33,3, 7–11 yaş grubunda %50,0 ve 11–15 yaş grubunda %67,7 (p=0,027). Lokorejyonel grupta preoperatif mYPAS skorları (13,2±1,4'e karşı 17,4±1,2) ve ebeveyn STAI-1 skorları (50,3±5,4'e karşı 60,9±6,4) daha düşük bulunmuştur (her ikisi için p<0,001). Bu fark tüm yaş gruplarında tutarlıdır. Ortalama ameliyat süresi lokorejyonel grupta daha kısadır (47,5±25,4'e karşı 58,8±27,8 dk; p=0,036) ve bu fark esas olarak 3–7 yaş grubundan kaynaklanmaktadır. Lokorejyonel anestezi planlanan bir hastada daha, beklenenden uzun süren cerrahi nedeniyle genel anesteziye geçilmesi gerekmiştir. Sonuç: Bu bulgular ışığında, lokorejyonel anestezinin el ve üst ekstremite cerrahisi uygulanan seçilmiş çocuklarda uygulanabilir olduğu sonucuna varılmıştır. Bu durum özellikle çocuk ve ebeveyn anksiyetesi düşük, kısa sürmesi beklenen işlem uygulanacak büyük yaştaki çocuklar için geçerlidir. Bu yöntem seçilmeden önce ameliyat süresinin gerçekçi biçimde öngörülmesi önemlidir. Objektif seçim kriterlerinin belirlenmesi için çok değişkenli analiz içeren prospektif çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

• el cerrahisi
• lökorejyonel anestezi
• preoperatif anksiyete

Kaynakça

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