Supraclavicular Block: Challenging but Safer Option in Obese Patient During Covid-19 Pandemic

Kamakshi Garg

doi:10.52916/jcar204003

Abstract

Introduction: Brachial plexus block is a boon for an anesthesiologist in difficult airway especially in the COVID-19 pandemic. The provision of regional anesthesia in this pandemic reduces the need for general anesthesia and the associated risk from aerosol-generating procedures. Case Report: A 35-year-old male weighing 130 kg with BMI 39.8 post-bariatric surgery 3 years back presented to casualty with the alleged roadside accident with fracture right midshaft humerus, right radius ulna, multiple facial injuries and suspected C3-C4 fracture. An USG guided supraclavicular block was given using 20 ml 2% lignocaine with adrenaline and 20 ml 0.75% ropivacaine. The patient shifted to COVID-19 post-anesthesia care unit for further management. Discussion: During the COVID-19 pandemic, regional anesthesia though challenging but considered the first choice and safer mode of anesthesia in COVID19 suspected patients with a difficult airway. The advent of USG has made supraclavicular nerve block safe for obese patients and reduce the risk of local anesthetic systemic toxicity. Conclusion: Supraclavicular brachial plexus block provides consistently effective anesthesia to the upper extremity. Also, recent advances in techniques of regional anesthesia have dropped the failure rates of the procedure.

Highlights

Brachial plexus block is a boon for an anesthesiologist in difficult airway especially in the COVID-19 pandemic
Supraclavicular brachial plexus block is a regional anesthetic technique used as an alternative or adjunct to general anesthesia providing better postoperative pain control for upper extremity surgeries
As the whole world is suffering from coronavirus disease (COVID-19), which had a great impact on the global healthcare system [2], anesthesiologists throughout are preferring regional techniques over general anesthesia

Summary

Introduction

Brachial plexus block is a boon for an anesthesiologist in difficult airway especially in the COVID-19 pandemic. Supraclavicular brachial plexus block is a regional anesthetic technique used as an alternative or adjunct to general anesthesia providing better postoperative pain control for upper extremity surgeries. This block is performed at the level of C5T1 nerve roots of the brachial plexus involving distal trunks to the proximal cords [1]. An ultrasound-guided supraclavicular block was given to an obese patient with a difficult airway posted for fixation of right humerus with both bone forearm fractures.

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