{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T06:10:41Z","timestamp":1775628641635,"version":"3.50.1"},"reference-count":44,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T00:00:00Z","timestamp":1775606400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"\n Background<\/jats:title>\n Pediatric surgical trauma can trigger the body's stress response, leading to immune dysfunction and affecting postoperative recovery. At present, nerve stimulator-guided brachial plexus block has been widely used in children, but its effect on immune function combined with laryngeal mask general anesthesia remains to be clarified.<\/jats:p>\n <\/jats:sec>\n \n Aim<\/jats:title>\n This study assessed the impact of combined brachial plexus block and general anesthesia on inflammatory, stress, and immune responses in children undergoing upper limb surgery.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n This retrospective propensity score matching (PSM) cohort study analyzed children undergoing upper limb surgery (June 2022-June 2024). Participants were stratified according to the anesthesia technique used during their upper limb surgery: the observation group received nerve stimulator-guided brachial plexus block, supplemented with laryngeal mask (LMA) general anesthesia, while controls received LMA general anesthesia alone. The primary outcome was the peripheral blood T lymphocyte subsets (CD3\n +<\/jats:sup>\n , CD4\n +<\/jats:sup>\n , CD8\n +<\/jats:sup>\n , CD4\n +<\/jats:sup>\n \/CD8\n +<\/jats:sup>\n ) and inflammatory cytokines (TNF-\u03b1, IL-6, IL-10) measured before anesthesia induction (T0), at the end of surgery (T1), and at 6\u2005h (T2), 24\u2005h (T3), and 72\u2005h (T4) postoperatively. Secondary outcomes included stress hormone levels [cortisol [COR], epinephrine [E], norepinephrine [NE]], anesthetic drug dosage, recovery time, extubation time, visual analog scale (VAS) scores, and postoperative adverse reactions.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n 1:1 PSM yielded 50 matched pairs with balanced baseline characteristics (all\n P<\/jats:italic>\n \u2009&gt;\u20090.05). The observation group required less intraoperative remifentanil, had shorter recovery and extubation times, and exhibited lower VAS scores at all postoperative time points (all\n P<\/jats:italic>\n \u2009&lt;\u20090.05). Immunological analyses revealed that the observation group maintained higher CD3\n +<\/jats:sup>\n and CD4\n +<\/jats:sup>\n cell percentages, along with an elevated CD4\n +<\/jats:sup>\n \/CD8\n +<\/jats:sup>\n ratio at T1-T4 timepoints (\n P<\/jats:italic>\n \u2009&lt;\u20090.05), whereas CD8\n +<\/jats:sup>\n cell levels were significantly lower at T2 (\n P<\/jats:italic>\n \u2009&lt;\u20090.05). Furthermore, the observation group exhibited attenuated inflammatory and stress responses, with lower concentrations of TNF-\u03b1, IL-6, cortisol, epinephrine, and norepinephrine at T1-T3, and lower levels of the anti-inflammatory IL-10 at T2 (\n P<\/jats:italic>\n \u2009&lt;\u20090.05). The overall incidence of postoperative nausea, vomiting, and restlessness was also significantly reduced in the observation group (\n P<\/jats:italic>\n \u2009&lt;\u20090.05).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Nerve stimulator-assisted brachial plexus block and LMA general anesthesia provides immunoprotection in children, enabling lower drug consumption, faster recovery, and fewer complications, thus proving clinically valuable.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fped.2026.1753902","type":"journal-article","created":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T05:33:22Z","timestamp":1775626402000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Immunomodulatory effects of nerve stimulator-guided brachial plexus block with laryngeal mask general anesthesia in pediatric upper limb surgery"],"prefix":"10.3389","volume":"14","author":[{"given":"Peng","family":"Pang","sequence":"first","affiliation":[{"name":"First Department of Anesthesiology, Hebei Medical University Third Hospital","place":["Shijiazhuang, Hebei, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shufeng","family":"Kang","sequence":"additional","affiliation":[{"name":"First Department of Anesthesiology, Hebei Medical University Third Hospital","place":["Shijiazhuang, Hebei, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qiujun","family":"Wang","sequence":"additional","affiliation":[{"name":"First Department of Anesthesiology, Hebei Medical University Third Hospital","place":["Shijiazhuang, Hebei, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Longbiao","family":"Zhao","sequence":"additional","affiliation":[{"name":"First Department of Anesthesiology, Hebei Medical University Third Hospital","place":["Shijiazhuang, Hebei, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jincheng","family":"Wang","sequence":"additional","affiliation":[{"name":"First Department of Anesthesiology, Hebei Medical University Third Hospital","place":["Shijiazhuang, Hebei, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rongtian","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Hebei Medical University Second Hospital","place":["Shijiazhuang, Hebei, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaoning","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Hebei Medical University Second Hospital","place":["Shijiazhuang, Hebei, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chunying","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, No. 256 Hospital of Zhengding","place":["Shijiazhuang, Hebei, 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