Safety and efficacy of ultrasound-guided distal forearm median nerve block for pediatric trigger thumb release: A retrospective observational study in a southern Chinese cohort

Xiang-Xuan Wang¹Wen-Chen Xu¹Tuan-Fang Fang²Zi-Hong Zhao³Kai-Nan Lin^1*Hui Chen^1*

• ¹Department of Pediatric Orthopedics, Fujian Children’s Hospital, College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
• ²Department of Anesthesiology, Fujian Children's Hospital , College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
• ³Graduate College of Fujian Medical University, Fuzhou, China

Purpose: The aim of this study was to evaluate the clinical outcomes of ultrasound-guided distal forearm median nerve block (UDFMNB) in children undergoing A1 pulley release. Methods: We conducted a retrospective analysis of the clinical data of unilateral pediatric trigger thumb(PTT) patients who underwent A1 pulley release under UDFMNB with ASA status I at a large pediatric hospital in South China from June 2021 to December 2024. Patients were divided into two groups based on age. The data collected included sex, affected side, age at onset, age at surgery, preoperative symptoms, Sugimoto staging, surgical time, operating room stay duration, block success rate, preoperative and postoperative range of motion of the thumb , and final follow-up time. Successful UDFMNB was defined as a complete sensory block without the need for additional analgesics or conversion to general anaesthesia. Pain intensity was assessed using an 11-point numerical rating scale, and the satisfaction of surgeons and parents of patients with anaesthesia was evaluated using a 7-point Likert scale. Complications were also recorded. Results: This study involved 65 patients (32 boys, 33 girls) with a median age at surgery of 1.8 years. The affected sides were left (n=29) and right (n=36), with 63 patients presenting with IP joint flexion contracture and 2 with extension. The cases of 12 patients were classified as Sugimoto stage III and the cases of 53 patients were classified as stage IV. After stratification by age, 21 and 44 patients were included in the two groups. The overall success rate of UDFMNB was 93.8%, with a higher failure rate in the ≤3-year group than in the >3-year group (4.62% vs. 1.54%). The operative duration was 15 (14–23) minutes, with no surgery-related complications. Two patients (one per group) experienced transient puncture-site redness. All patients regained thumb mobility without reoperation. The median NRS pain scores were 2 intraoperatively and 1 postoperatively, with no intergroup differences. Conclusion: Satisfaction scores were high among surgeons and parents of patients. In conclusion, UDFMNB has high success rates and an excellent safety profile for analgesia in PTT release surgery, making it suitable for clinical application and wider adoption.