Bilateral infraclavicular Block in a High-Risk Patient

Öz

Brachial plexus block is an anesthetic technique which is used in forearm fracture surgery. It provides a good intraoperative anesthesia along with a long postoperative analgesia. However,
bilateral brachial plexus block is rarely used due to risk of systemic local anesthetic toxicity. Hence, general anesthesia is usually used in bilateral extremity surgery. In this report, we aim to share our experience of bilateral infraclavicular block in a 71-year-old female, high risk patient who had an operation due to bilateral radius fracture. With using nerve stimulator (Stimuplex, HNS 11; Braun Melsungen, Melsungen, Germany), flexion of fingers was ensured (0.40 mA with impulse duration of 0,1 sec) and then 20 mL of local anesthetic was administered to each plexus. No complication was observed.

Anahtar Kelimeler

• Infraclavicular block
• Bilateral brachial
• plexus block

YÜKSEK RİSKLİ BİR HASTADA BİLATERAL İNFRAKLAVİKULAR BLOK

Öz

Brakial pleksus blokajı önkol fraktür cerrahisinde uygun bir anestezik yaklaşımdır. İntraoperatif iyi bir anestezi hem de postoperatif uzun süre analjezi sağlayan bir tekniktir. Bilateral brakial pleksus bloğu sistemik lokal anestezi toksisitesi nedeni ile nadiren uygulanır. Bu nedenle bilateral ekstremite operasyonlarında sıklıkla genel anestezi tercih edilir. Biz bu yazımızda bilateral radius fraktürü nedeni ile opere edilecek yüksek riskli 71 yaşında bayan bir hastada uyguladığımız bilateral infraklavikular blok deneyimimize sunmayı amaçladık. Sinir stimulatörü (Stimuplex, HNS 11; Braun Melsungen, Melsungen, Germany) yardımı ile parmakların fleksiyonu (0.40 mA ve impuls süresi 0,1 sn’de) elde ettikten sonra her iki pleksusa 20’şer ml lokal anestezik karışımı enjekte edildi. Herhangi bir komplikasyon gelişmedi.

Anahtar Kelimeler

• İnfraklavikular blok
• Bilateral brakial
• pleksus blokajı

Kaynakça

1. Lierz P, Schroegendorfer K, Choi S, Felleiter P, Kress HG. Continuous blockade of both brachial plexus with ropivacaine in phantom pain: a case report. Pain 1998;78:135–7. 2. Maurer K, Ekatodramis G, Rentsch K, Borgeat A. Interscalene and infraclavicular block for bilateral distal radius fracture. Anesth Analg 2002;94:450-2. 3. Klein SM, Evans H, Nielsen K, Tucker M, Warner D, Steele S. Peripheral nerve block technique for ambulatory surgery. Anesth- Analg. 2005;101:1663–76. 4. Koscıelnıak-Nıelsen Z. J., Rasmussen H., Hesselbjerg L., Nıelsen T. P. And Gurkan Y. Infraclavicular block causes lee discomfort than axillary block in ambulatory patients”, Acta Anaesthesiol Scand.2005, 49: 1030-4. 5. Rettıg H. C., Gıelen J. M., Boerma E. And Kleın J. A comparison of the vertical infraclavicular and axillary approaches for brachial plexus anesthesi, Acta Anaesthesiol Scand.2005, 49:1501-8. 6. Raj PP, Montgomery SJ, Nettles D and Jenkis MT: Infraclavicular brachial plexus block-A new approach . Anesth. Analg, 1973; 52: 897. 7. Holborow J, Hocking G. Regional anaesthesia for bilateral upper limb surgery: a review of challenges and solutions. AnaesthIntensive Care. 2010;38:250–8. 8. Franco CD, Salahuddin Z, Rafizad A. Bilateral brachial plexus block. Anesth Analg. 2004;98:518–20.