Title : Ultrasound-guided peripheral nerve block for upper limb surgery: Case report
Abstract:
Introduction: The supraclavicular block is a regional anesthetic technique used as a sole type of anesthesia for upper limb surgery (mid-humerus through the hand), adjunct to general anesthesia or used for postoperative pain control. This block is an excellent alternative to general anesthesia in patients with cardiac and pulmonary comorbidities, for upper limb surgery
Case study: A 66-year-old male AA was admitted to the Clinic for Orthopedic Diseases in Skopje for surgical treatment of a fracture of the proximal part of the upper limb. After the performed anesthesiological examination, it was determined that the patient had wheezing and crepitations in the distal parts of the lungs, cardiomyopathy and ischemic heart disease previously untreated and Diabetes mellitus type II. The patient was scheduled for open fixation of the fracture. The choice for perioperative management was the performance of a supraclavicular brachial plexus block, as the most non-invasive technique, taking into account the patient's health condition. Intraoperatively, the patient was stable with normal vital parameters. After 2 days of treatment, he was discharged from the clinic and in stable condition.
Discussion: Peripheral nerve blocks are of significant interest not only for anesthesiologists but also for surgeons, considering the benefit to the patient, especially good pain relief and thus patient satisfaction with the type of anesthesia and surgical intervention, as well as the possibility of early discharge from the hospital. 14 It can be performed as a bilateral continuous technique for bilateral interventions on the both upper limbs. 15,23 Peripheral nerve blocks are particularly suitable and safe for outpatient interventions such as shoulder and knee arthroscopy, hand contractures and other short interventions 19 and especially for the patients with severe hart and lung conditions
Conclusion: Pulmonary and cardiac preoperative comorbidity, especially if previously untreated, represents a high risk for peri- and postoperative complications. Peripheral nerve block, in our case supraclavicular brachial plexus block, proved to be a safe choice for the type of anesthesia for upper limb surgery, without the occurrence of postoperative complications. 16,17,18
Keywords: Peripheral nerve blocks, supraclavicular block, fracture of upper arm, anesthesia, postoperative complications.
