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