Abstract
Traumatic injuries affecting bones of the hand and forearm often require peripheral nerve blocks for analgesia and surgical intervention. The successful use of subclavian perivascular block as a sole anaesthetic for orthopaedic surgery has not been reported in our environment. We report the use of this technique for open reduction and internal fixation of a left midshaft humeral fracture. The trunk of the brachial plexus was localized by a Polystim II nerve stimulator. Complete sensorimotor block was achieved within 15 minutes and surgery lasted 55 minutes without complications. This technique obviated the use of general anaesthesia with its risks. The surgeon and the patient were satisfied with the quality of the anaesthesia.
Keywords: Regional anaesthesia, peripheral nerve block, subclavian perivascular block, orthopaedic upper limb surgery
Résumé
Les blessures des traumatismes affectant les os de la main et l avant bras nécessitent le blocage du nerf périphérique par intervention antalgique et chirurgicale. le succès du blocage de la perivascualire subclaviane comme principal anesthétique dans la chirurgie orthopédique n a pas été rapporte dans notre environnement. Nous rapportons l’utilisation de cette technique pour réduire et une fixation interne de la fracture de l humérus gauche. le tronc du plexus branchiale était localisé par un stimulateur du polystime du nerf II . le blocage complète sans moteur était accompli entre 15 minutes et la chirurgie dura pour 55 minutes sans complications. Cette technique dominait l usage de l anesthésie générale avec de risques. Le chirurgien et le pattues étaient satisfaits de la qualité de l anesthésie.
Introduction
Regional anaesthesia has become an important technique for surgical intervention and pain management for patients undergoing orthopaedic upper limb surgeries [1]. This is true for trauma where a site specific anaesthetic is an advantage with minimal haemodynamic disturbance [2]. With these techniques, opioid requirements are reduced and side effects associated with opioids or general anesthetics such as nausea, vomiting, sedation and respiratory depression are avoided [3,4]. However, peripheral nerve blockade is often perceived to be time consuming and undependable as a sole anaesthetic. It is seldom performed in Nigeria and particularly at the University College Hospital, Ibadan for upper limb surgery. We present a 24 year old female with a left closed comminuted fracture of the humerus who had subclavian perivascular block for surgery.
Correspondence: Dr. Amby Rukewe, Department of Anaesthesia, University College Hospital, Ibadan, Nigeria. Email: ambrukewe@yahoo.com
References
Hickey R, Garland TA and Ramamurthy S. Subclavian perivascular block: influence of location of paraesthesia. Anesth Analg 1989; 68: 767– 771.
Elliot JM. Regional anaesthesia in trauma. Trauma 2001; 3: 161 – 174.
Chung F and Mezei G. Factors contributing to prolonged stay after ambulatory surgery. Anesth Analg 1999; 89: 1352 – 1359.
Klein S, Evans H, Nielsen KC, Tucker MS, Warner DS and Steele SM. Peripheral nerve block techniques for ambulatory surgery. Anesth Analg 2005; 101: 1663 – 1676.
Lanz E, Theiss D and Jankovic D. The extent of blockade following various techniques of brachial plexus block. Anesth Analg 1983; 62: 55 – 58.
Tran De QH, Clemente A, Doan J and Finlayson RJ. Brachial plexus blocks: a review of approaches and techniques. Can J Anesth 2007; 54: 662 – 674.
Neal JM, Hebl JR, Gerancher JC and Hogan QH. Brachial plexus anesthesia: essentials of our current understanding. Reg Anesth Pain Med 2002; 27: 402 – 428.
Bhat RV. Impaling injury to the upper limb: an interesting case report. Indian J Anaesth. 2003; 47: 225 – 226.
Liguori GA, Zayas VM, YaDeau JT, et al. Nerve localization techniques for interscalene brachial plexus blockade: a prospective, randomized comparison of mechanical paresthesia versus electrical stimulation. Anesth Analg 2006; 103: 761 – 767.
Franco CD and Vieira Z. 1001 Subclavian perivascular brachial plexus blocks: success with a nerve stimulator. Reg Anesth Pain Med 2000; 25: 41 – 46.
Boezaart AP, de Beer JF, du Toit C and van Rooyen K. A new technique of continuous interscalene nerve block. Can J Anesth 1999; 46: 275 – 281.
Horlocker TT. Comfortably numb (at home): Perioperative application of peripheral nerve blocks. Revista Mexicana de Anestesiología. 2006; 29: S44 – S50.
Kessler J and Gray AT. Sonography of scalene muscle anomalies for brachial plexus block. Reg Anesth Pain Med 2007; 32: 172 – 173.
Winnie AP and Collins VJ. The subclavian perivascular technique of brachial plexus anaesthesia. Anaesthesiology 1964; 25: 353.