Ultrasound Guided Supraclavicular Brachial Plexus Block for Humerus Fracture in a Patient with Eisenmenger Syndrome

Abstract

Eisenmenger syndrome is a pulmonary vascular disease in which pulmonary-systemic circulation is connected due to bidirectional shunt caused by congenital heart disease, leading to increased pulmonary vascular resistance and right ventricular failure. Intraoperative management is a challenging task for anesthesiologists when patients with Eisenmenger syndrome undergo non-cardiac surgery, and maintaining both systemic vascular resistance and pulmonary vascular resistance during surgery is critical. In this case, we report that a patient with Eisenmenger syndrome with a humerus fracture successfully underwent open reduction with internal fixation by performing ultrasound guided supraclavicular brachial plexus block and was discharged without complications. When upper limb surgery is performed in patients with Eisenmenger syndrome, ultrasound guided supraclavicular brachial plexus block has fewer hemodynamic changes such as decreased systemic venous resistance and increased pulmonary vascular resistance compared to general anesthesia, and could be a safe anesthetic method in terms of postoperative pain control.