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.

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 American Society of Anesthesiologists (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 (≤3 years and >3 years). 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 IP joint, and final follow-up time. Successful UDFMNB was defined as a complete sensory block without the need for additional analgesics or conversion to general anesthesia. Pain intensity was assessed using an 11-point numerical rating scale (NRS), and the satisfaction of surgeons and parents of patients with anesthesia was evaluated using a 7-point Likert scale. Complications were also recorded. Results: This study involved 65 patients (32 boys and 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. Using the Sugimoto staging system, the cases of 12 patients were classified as 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) min, 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 pediatric trigger thumb release surgery, making it suitable for clinical application and wider adoption.