Ultrasound-Guided Supraclavicular Block in a Patient with Toxic Goiter and Exposed Wrist Fracture

Guadalupe Zaragoza

doi:10.4172/2165-7548.1000177

Abstract

We report the case of an elderly woman with cervical deformity due to a large diffuse goiter and predictive data for a difficult airway, alteration of all thyroid hormone levels and an exposed wrist fracture. After a pre-block ultrasound scan, the supraclavicular approach to the brachial plexus was selected because the gland growth was in the anterior to posterior axis, without displacement of the anatomical structures in the neck. We then proceeded to insert the needle using an in-plane technique with a linear probe in an oblique coronal plane to inject the local anesthetic and observe its adequate diffusion. Excellent anesthesia was achieved for the surgical procedure avoiding other complications.

Highlights

The use of ultrasound-guidance (US-G) for localization of neurovascular structures allows for real-time visualization of the anatomy
We present the case of a patient with a hyper-functioning goiter and a predicted difficult airway
The infraclavicular approach was considered, after a very careful sonographic survey, it was realized that the anatomy of the supraclavicular plexus was well preserved and it was decided to proceed with the supraclavicular approach [4,5] Revealing an infiltrative thyroid mass (Figure 3)

Summary

Introduction

The use of ultrasound-guidance (US-G) for localization of neurovascular structures allows for real-time visualization of the anatomy. The impact of an enlarged thyroid gland in a supraclavicular approach has not been previously reported [1,2,3]. We present the case of a patient with a hyper-functioning goiter and a predicted difficult airway.

Results

Conclusion