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

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