Roadside Accident Research Articles

Examining drivers’ distracted driving behaviour using the extended norm activation model

A driving distraction is any external or internal stimulus that diverts a driver’s attention away from the primary task of safe vehicle operation, potentially increasing the risk of accidents. Drivers often get involved in distractions such as phone calls, text messaging, interacting with in-vehicle technology, roadside advertisements, roadside accident sites, and chatting with passengers, etc. In previous research, the antecedents of distraction behaviour have primarily been investigated through the theory of planned behaviour (TPB). Refraining from distracted driving can be considered a pro-social behaviour and can be modelled using the norm activation model (NAM). Therefore, this study aimed to evaluate the potential of pro-social behaviour in explaining drivers’ distracted driving behaviour using the NAM theory. In addition to the conventional factors of the NAM model – awareness of consequences (AC), ascription of responsibility (AR), and personal norms (PN) – this study presents a novel element that examines how technology can mitigate distractions. The data was collected in Lahore city through a questionnaire survey. The results indicate that AC and AR have positive associations with PN, however, PN has also been found to have a positive association with the distraction behaviour. This study provides insights into the utilisation of the NAM theory to evaluate the potential of altruistic behaviour in preventing individuals from engaging in distracted driving.

Isolated Gastric Perforation following Blunt Trauma Abdomen not to be Missed: A Case Series

Abdominal trauma is a commonly encountered emergency which may be because of roadside accidents, assaults, or falls from height. Blunt injury to the abdomen is far more common than penetrating injury. Gastric perforation commonly occurs following penetrating abdominal trauma. However, gastric rupture is an uncommon entity following blunt trauma abdomen (BTA). Here, we are presenting three cases of isolated gastric perforation after BTA, two were due to a roadside accident, and one was a result of a fall from height. History suggests of a full stomach is usually found in traumatic gastric rupture. This condition usually presents with insignificant clinical or radiological signs. Isolated gastric rupture due to trauma is rare as it is usually associated with other injuries such as splenic and liver injuries. Early suspicion plays an important role in diagnosing this entity which carries higher morbidity and mortality if not managed timely. As isolated gastric perforation because of trauma leads to high morbidity and mortality, hence thorough lavage of the peritoneal cavity followed by double-layer closure after adequate debridement will reduce chances of intraperitoneal contamination thus improving outcome. Presentation after the last meal, the severity of gastric rupture, and other associated injuries play an important role in the prognosis of the patient.

Awareness and Practice on Road Safety among Adults in Selected Area of Jalandhar Cantt, Punjab

It has been estimated that one million death and 15 million road side accident occur on the road worldwide. Globally road side accidents are the 7th leading cause of death in all age groups. In India we have 1% of the world vehicle population, but 6% of the world accidents 1. The aim of the study is to assess the awareness and practice on road safety among adults in in selected area of Jalandhar Cantt, Punjab. A total of 108 samples were selected for the study and samples were the adults with in the age group of 18-60 years. The major findings of the study were as follows: The study analysis showed that majority (69%) of the samples were males and 60% belonged to the group of 18-30 years of age. 15% of samples were drivers by profession, 63.8% had a valid driving license. Majority of samples, (83.2%) had good awareness on road safety and 94% of samples had good practice on pedestrian road safety. The study showed that there was a low positive and significant correlation between awareness and practice among pedestrians (n=400) as the p value is .001 and spearman’s rho value is 0.269. And there was a low and significant correlation between awareness and practice of drivers the p value is .001 and spearman’s rho value for 0.322.

Complete gastroduodenal transaction in a blunt abdominal trauma patient: a rare case report

Complete gastroduodenal transaction following blunt abdominal trauma in a road side accident is a rare and potentially life-threatening condition. The course of management and choice of surgical intervention depends on clinical presentation; site, size, nature of defect; amount of tissue and blood loss. In this case report, the clinical presentation, diagnostic evaluation, surgical management and postoperative course of an 18-year adult male patient who presented to the emergency room with complaints of generalized abdominal pain, vomiting and signs of peritonitis following a road side accident suggesting bowel injury. The patient was diagnosed with complete gastroduodenal transaction following blunt abdominal trauma based on radiological imaging and intraoperative findings. The patient underwent emergency laparotomy and primary repair of gastroduodenal transaction with Witzel jejunostomy for better outcome. This case report underscores the early recognition, diagnosis and prompt surgical intervention in cases of complete gastroduodenal transaction following blunt abdominal trauma to achieve favourable patient outcomes.

MANAGEMENT OF LOWER LIMB TRAUMA IN PREGNANCY

Objective: Lower limb fracture in pregnancy is a rare complication. Still, there is limited literature available on the management of these fractures, and perioperative obstetric and orthopedic management of these fractures is largely unclear. Trauma during pregnancy is a common cause of non-obstetrical maternal death and a significant public health burden. This study reviews the common causes of lower limb trauma during pregnancy, morbidity, mortality, and provides a management approach to pregnant patients with lower limb trauma. Methods: A prospective analysis was conducted in the orthopedics department of Government Medical College, Patiala from 2019–2022 on 30 pregnant patients admitted here with lower limb fractures.18 patients presented with femoral fractures and 12 patients with tibial fractures. Details of the type of fracture and site of fracture, along with the type of intervention, were recorded. Roadside accident was the most common cause of trauma, followed by fall and then assault. Results: The following observations were made from the data collected during this study in the treatment of 30 cases of lower limb trauma during pregnancy. The mean age of patients in the study was 27 years. The most common cause of trauma was traffic accidents, followed by fall and assault. In our study, 18 patients (60%) presented with femoral fractures, and 12 patients (40%) with tibial fractures. Operative intervention was done for all femoral fractures and 6 tibia fractures.6 tibial fractures were managed conservatively. Among 18 femoral fractures, 15 were operated with plating and 3 with interlocking femur nails. Among 6 operated tibia fractures, 2 were operated with plating and 4 with interlocking tibia nail. All cases were evaluated with risks and benefits of operative treatment, positioning of the patient, type of anesthesia used, use of c-arm, radiation dose, intraoperative fetal monitoring and the risk associated with anesthetic agents, antibiotics, analgesics, and anticoagulants. Conclusions: Orthopedic trauma during pregnancy is usually associated with significant morbidity and mortality to the mother as well as fetus. A multidisciplinary approach should be used for the successful management of lower limb fractures during pregnancy. The orthopedic surgeon must consider both operative and non-operative measures. Risk and benefits of operative treatment must be weighed carefully. Many fractures during pregnancy can be managed conservatively based on the fracture pattern and displacement. Also, we can delay the operative treatment until after delivery which is often a safe option. In fractures where surgical intervention is necessary, orthopedic surgeons must consider the physiologic changes that accompany pregnancy and the potential risks to the fetus. The surgeon must take care of the proper positioning of the patient, use of the c-arm, radiation dose, and intraoperative fetal monitoring. Furthermore, the risk associated with anesthetic agents, antibiotics, analgesics, and anticoagulants must be taken care of.

Treatment of Gangrenous Phalanx using combination therapy of Platelets Rich Plasma (PRP) and Photo Bio Modulation (PBM)

Gangrene is a dangerous and potentially fatal condition that happens when the blood flow to an area of tissue or organ is cut off. This causes the tissue to break down and die. Gangrene often turns the affected skin a greenish-black color. Due to poor attention and unhygienic conditions, this becomes more contaminated and in the end amputation remains the only treatment option. Traditional therapies cannot provide necessary growth factors to regenerate. Platelet Rich Plasma (PRP) helps in wound healing process by releasing various growth factors. Photo bio modulation (PBM) is also reported for this purpose. Objectives: To evaluate the safety and efficacy of PRP and PBM for the treatment of dry gangrene in the fractured little finger in a roadside accident. Methods: We report a case of a twenty-seven-year-old male with fractured little finger (Phalanx) in a roadside accident. The patient reported after 6 weeks with dry gangrene and severe pain. The patient treated with combination of PRP and PBM. Results: Over a follow up of six weeks, significant improvement was shown with decrease in pain. Little finger was recovered that was showing mobility and growing nail. Conclusion: It is concluded that PRP along with PBM is an effective treatment for dry gangrene.

Study of Roadside Accident Prediction of a Multibridge and Multitunnel Section on an Expressway in a Mountainous Area

In order to ensure the roadside traffic safety of a multibridge and multitunnel section on an expressway in mountainous areas, optimize the roadside traffic facilities, and reduce the road traffic accidents caused by the overly frequent changes of the driving environment among the bridge group and tunnel group and their intervals, combined with the driving rules, the prediction model of the numbers of roadside accidents, passenger and freight vehicle accidents in a multibridge and multitunnel section on an expressway in mountainous areas is established using statistics, machine learning, and other related theories. To analyze the influence of the driving environment of the expressway on drivers’ visual, psychological, and operational characteristics, ten prediction indicators are selected from the aspects of road alignment, traffic structure, traffic environment, and weather conditions. The action mechanism between roadside accidents and the ten predictive indicators is explained by employing Spearman correlation analysis. The roadside accident prediction model based on BPNN, GA-BPNN, and PSO-BPNN are established. MAE, RMSE, and MAPE are used as the model evaluation indicators to select the optimal model. The roadside accident data including rollover, side collision, and collision with fixed objects are verified with examples using the accident patterns of Chongqing–Hunan Expressway in the past five years. The results show that (1) the roadside accidents of a multibridge and multitunnel section on an expressway in a mountainous area are comprehensively affected by ten prediction indicators, which are positively correlated with the length of road section, the proportion of curved roads, and the proportion of bridges, and the influence of the length of the road section is the greatest indicator; (2) compared with BPNN and GA-BPNN prediction models, the errors of MAE, RMSE, and MAPE of PSO-BPNN are reduced by 18.5%, 17.65%, and 24.16% on average, and the model prediction error is smaller and the accuracy is higher; and (3) the accurate prediction of the number of roadside accidents and the number of passenger and freight vehicle accidents can provide effective decision-making support for the optimization design of roadside facilities.

INCARCERATED ACUTE TRAUMATIC ABDOMINAL WALL HERNIA : A RARE ENTITY

Acute traumatic abdominal wall hernia is a rare type of hernia that occurs after a low or high velocity impact of the abdominal wall against a blunt object only few cases have been reported in literature. We report a case where a high velocity impact due to roadside accident caused a traumatic abdominal wall hernia in a 48-year-old male patient. The physical examination ndings revealed the presence of traumatic abdominal wall with gut lying just below the fat of anterior abdominal wall which was which was conrmed on USG. Patient was managed by exploratory laparotomy with resection and ileo-ileal anastomosis. The post operative period was uneventful. It is important to emphasize the importance of the physical examination in such cases to make early diagnosis. Urgent surgical intervention is recommended to avoid wound and bowel related complications.

Management of Rare Complication of Implant Fracture After Road Side Accident: A Case Report

Management of Rare Complication of Implant Fracture After Road Side Accident: A Case Report

TRAUMATIC PHACOCELE IN 55 YEARS OLD WOMAN FROM CHENNAI, INDIA

A 55-years-old woman presented with profound sudden loss of vision in left eye (LE) after an injury in a road side accident. She had normal right eye. Left eye had perception of light (PL) with accurate projection of light (PR) in all quadrants, total hyphema, chemosis in supero-nasal conjunctiva and normal intraocular pressure (IOP). B-scan of LE showed extrusion of the lens into the supero-nasal subconjunctival space called phacocele, and vitreous hemorrhage. Wound exploration was done with removal of expelled lens and the scleral wound was sutured with 6/0 vicryl, followed by 25G pars plana vitrectomy with fluid gas exchange. Secondary IOL implantation is planned in next visit.

ROLE OF CROSS LEG FLAPS IN LEG AND FOOT RECONSTRUCTION: OUR EXPERIENCE

Introduction: The management of compound trauma has always been challenging. Free aps are the rst choice when soft tissue cover cannot be provided by local aps. When facilities for microsurgery are not available or certain factors preclude the microsurgical anastomosis or in cases of free ap failure, the cross leg aps have a big role to play in lower limb reconstruction. We are presenting our retrospective study on 30 cases of distal leg and foot defects covered successfully by cross leg aps. The aim of this study is to highlight the usefulness of cross legAims and objectives: aps in lower limb reconstruction. A retrospective study was done on 30 patients from January 2015 toMaterial and methods: December 2021 who underwent perforator based fasciocutaneous cross leg ap for post traumatic soft tissue defects of distal leg and foot. The mechanism of injury, size and site of defect were recorded. All aps were planned in reverse and limbs were immobilised with external xator. Post-operative complications if any were noted. The patients were followed till the ap became stable. The mechanism of injury was road side accident in 26 cases, machine injury in 2 cases and fall fromResults: height in 2 cases. 19 patients had soft tissue defect of distal 1/3rd of leg and 11 patients had foot defects. 26(86.67%) patients underwent distally based fasciocutaneous cross leg ap and 4(13.33%) patients underwent conventional anteromedially based fasciocutaneous ap. All aps survived well. 2 patients had discharge and 1 had margin necrosis but were managed conservatively. The perforators based fasciocutaneous cross leg aps provide an easy, simple, reliable and viableConclusion: cover for distal leg and foot reconstruction.

DMAIC methodology for achieving public satisfaction with health departments in various districts of Punjab and optimizing CT scan patient load in urban city hospitals.

The health care delivery system in Pakistan is in a process of rapid growth, and it consists of public and private sectors. The provincial government is preliminarily responsible for providing health care facilities within its province except in federally administered areas. In Pakistan, there are three tiers of governmental healthcare delivery systems, which comprise government, semi-government, and parastatal organizations. The purpose of this study is to understand the rapid increase in influx of patients in major city hospitals of the Punjab province. The reasons for patient flow towards the major city areas can vary, but our point of focus is mainly on those patients who are prescribed to get a computed tomography (CT) scan done for better diagnosis and early treatment, including but not limited to roadside accident cases. The study targets the define, measure, analyze, improve and control (DMAIC) problem solving approach to assess the potential cause of CT patient flow and the challenges that the health department is facing to cater to such a patient niche and process while minimizing the congestion in city government hospitals. The approach in this study summarizes with numerous quality tools like Voice of Customer (VOC) which is customer feedback, Customer Output Process Input and Supplier (COPIS) processes use for high-level process map to know what your customer value, Approver Resource Member Interested (ARMI) chart which is use to analyze the stakeholders on management of the project, evaluation with the help of fishbone diagram and house of quality, and for process improvement methodology we use the team brainstorming technique and the kaizen 5-why technique. The technique came up with an idea of a public-private partnership (PPP) project—partnership between public agency and private firm, as the health care industry in Punjab province is going through budgetary issues. In a PPP project, the Government will allocate the space to a private firm to build the facility on their own and provide quality service for CT scan diagnosis to the public of Punjab. The study identified the top 10 critical factors that the patients have expected from the government to be provided on priority. The Kaizen process improvement methodology has been adopted to provide the possible solution of government budgetary issues. The set of tools in this study can be adopted by other PPP projects to enhance the project performance.

Research on Highway Roadside Safety

Frequent and serious traffic accidents have become a focal issue because they hinder the sustainable development of society. In China, roadside accidents account for 40% of fatalities resulting from traffic accidents. Roadside safety has become an important issue of traffic management departments worldwide, and performing research on roadside safety contributes to improving the level of road safety and reducing the number of traffic accidents and fatalities. By systematically sorting a large number of relevant studies, this paper analyzed the current development trends of roadside safety in terms of three aspects (i.e., the year of publication, the country of publication, and the source of publication) and then summarized the research status, existing gaps, and future development directions of roadside safety in terms of three aspects: the frequency of roadside accidents, the severity of roadside accidents, and the practice of roadside safety design. This paper reviewed the different prediction methods and evaluation models for the frequency and severity of roadside accidents. According to the number of times mentioned in the literature, the first five significant risk factors that cause frequent roadside accidents are small-radius curves, heavy traffic, objects adjacent to the lane (such as poles and trees), narrow lanes, and narrow shoulders, and the first five significant risk factors that cause fatal roadside accidents are driver age ≤25 or ≥65, alcohol, speeding, failure to use seat belts, and heavy trucks. Future research on the frequency and severity of roadside accidents should focus on quantitatively analyzing the probability of roadside accidents and occupant injury risk and developing methods for identifying roadside accident blackspots. For roadside safety design, roadside clear zones and safety slopes should be precisely quantified based on a cost-benefit analysis in future studies.

Accident Hotspots in Southern Expressway of Sri Lanka: Interpolation Evaluation using GIS

In this study, the southern expressway, which is the first and lengthiest E class highway (126 km) in Sri Lanka, was analysed for roadside accident incidences. The primary objective of this paper is to identify the best-fit interpolation techniques for the hotspots' most distinctive causes of vehicular crashes. The accident details were collected from the Police Headquarters consisting of 966 accidents that took place during the period from 2015 to 2017. To identify accident hotspots, GIS-based interpolation techniques such as Ordinary Kriging, Kernel Density Estimation (KDE), Inverse Distance Weighting (IDW), and Nearest Neighbour Interpolation methods were used. The spatial interpolation outcome of the four methods was compared based on the standard Prediction Accuracy Index (PAI). The analysis was executed using QGIS and GeoDa. Results of PAI revealed that an IDW and KDE outperformed the other two interpolation methods. The left and right lanes of the expressway, spotted with 11 and 20 hotspots, respectively, indicate the right lane was 50% more prone to accidents than the left lane. Notably, nearly 5% of the entire road stretch is estimated as accident-prone spots in both lanes. Peak accidents were recorded during afternoon and evening hours, and buses were the most active vehicle type. Uncontrolled speeding was the primary reason for more than 50% of the accidents, while unsuccessful overtake accounted for more than 20% of the accidents on the highway. The road design modifications and warning sign placements at appropriate places may be recommended as countermeasures.

Evaluating the predictive factors affecting outcome in patients with severe traumatic brain injury: a prospective observational study

Background: Severe traumatic brain injury (TBI) is a neurosurgical emergency and timely intervention is critical for favorable outcome. We aimed to evaluate certain demographic, clinical and radiological factors for outcome prediction in TBI patients in terms of morbidity and mortality.Methods: A prospective observational study was conducted in 100 patients of severe TBI admitted to our hospital from September 2016 to June 2018. Those with penetrating head injury, associated severe chest, abdominal or orthopedic trauma and pregnant or lactating women were excluded. Clinical outcome was assessed at the time of discharge and after three months according to Glasgow outcome score (GOS).Results: Majority of patients were adults in the age group 20 to 39 years. Road-side accident (75%) was the commonest mode of injury followed by fall (23%) and assault (2%). Out of 100 patients, 51 had in-hospital mortality. Of 49 patients who survived for GOS assessment at 3 months, three (6.1%) patients had unfavourable GOS I to III. Presence of hypoxemia, pupil non-reactivity, computerised tomography (CT) head findings of hemorrhagic contusion, subarachnoid hemorrhage (SAH), midline shift and effacement of basal cisterne were associated with significantly increased risk of unfavorable early and late outcome after severe TBI (p<0.05). Poor GCS score and fracture skull were associated with adverse early and late outcome respectively (p<0.001).Conclusions: Low GCS score at admission, pupil non reactivity, presence of hypoxemia, abnormal CT head findings (hemorrhagic contusion, SAH, midline shift and effacement of basal cisterne) were strong predictors of adverse outcome after severe TBI.

Complications with Ilizarov ring fixator in open tibial fracture

Introduction: The management of infected nonunion of the tibia is challenging, particularly with segmental bone loss, multiple draining sinuses, poor soft tissue cover, osteopenia, adjacent joint stiffness, limb deformity, or multidrug-resistant polymicrobial infection. The Ilizarov method permits early rehabilitation and addresses all the problems such as non-union, infection, shortening, soft tissue loss and deformity simultaneously at single stage. Ilizarov ring fixation technique has its own advantages as well as associated complications. Methods: The present study was a prospective randomized open study in which aim was to evaluate Complications with Ilizarov ring fixator in open tibial fracture. The study was conducted in 30 skeletally mature patients in Department of Orthopaedics, SGRD University of health sciences, Amritsar from July 2017 to May 2019. The patients were assessed clinically based on history and physical examination. Radiological evaluation using plain antero-posterior and true lateral radiographs of the involved leg was done and evaluated by complications.Results: Mean age was 37.7 years. Out of 30 cases 24(80%) were male and 6(20%) were female. Right tibia was involved in 24 cases out of 30 cases. 29 cases had history of road side accident and 1 had history of fall from height. In present study following complications were noted, limp in 12 cases(40%), ankle stiffness in 7 cases(23.33%), pin site infection in 9 cases(30%), limb oedema in 7 cases(23.33%), knee stiffness in 3 cases(10%), loosening of pins in 2 cases(6.67%), deformity in 2 cases(6.67%) and refracture in 1 case(3.33%). There was no complication of neurovascular injury, malunion, breakage of wires, axial deviation or limb length discrepancyConclusion: Limp and Pin tract infection were the most common complications. Most complications can be prevented by diligent post-operative care. Complications if diagnosed early can be managed effectively. As such advantages of Ilizarov ring fixator outweigh the associated complications.

Is Hip Spica an Obsolete Method for Paediatric Femur Fractures ? - A Retrospective Analysis of 58 Patients

Background- Diaphyseal femur fracture in paediatric age group are common in orthopaedics with treatment options varying from conservative methods such as hip spica to operative measures such as nailing/plating. We analyzed results of patients treated conservatively in a hip spica cast. Material and Methods- 58 patients, upto 5 years of age, with shaft femur fracture managed by hip spica cast were retrospectively analysed in terms of healing clinically and radiologically and complications noted, if any. Results- Fracture healed satisfactorily in all patients. Mean age of patients affected was 3.8 years. Males were more affected and road side accident was most common etiology. Mean hospital stay was 3.4 days. Most common complication was skin breakage (27.58%) followed by cast soiling or breakage (13.79%) while shortening was seen in 3 patients (5.1%) and angulation in 2 patients (3.44%). Conclusion- Despite newer and safer implants, hip spica remains safe and cost effective method for treatment of femur fracture in children.

Outcome and its predictors in traumatic brain injury in elderly population: Institutional study from Northern India

Introduction:Traumatic brain injury (TBI) is a leading cause of death and disability worldwide. Survival and functional outcome is significantly poor in the elderly population. There is a need to develop better geriatric specific prognostic models and evidence-based geriatric traumatic brain injury management protocols for better treatment, rehabilitation, and prevention.Aims and objectives:To study the frequency, outcome and correlates of traumatic brain injury in elderly patients.Material and Methods:Frequency, outcome and correlates of traumatic brain injury in patients more than 65 years of age admitted in tertiary care hospital were studied in 160 patients admitted between 1st January 2016 and 31st December 2016 (retrospective analysis) and between 1st January 2017 and 30th June 2018 (prospective analysis). Institutional ethical committee approval was taken.Results:This study concluded that road side accident was the most common cause of traumatic brain injury in elderly in this study. Incidence of traumatic brain injury in elderly was found to be 11.45%. Both non-reacting pupils and low Glasgow coma scale on arrival were significantly associated with poor outcome in terms of mortality. Most of the patients who expired or were discharged against medical advice had associated skull bone fractures, cerebral infarct, diffuse brain edema, subarachnoid hemorrhage, midline shift, lower hemaglobin, higher random blood sugar and higher creatinine as compared to patients who were discharged. All these findings were statistically significant.Conclusion:Low Glasgow coma scale on arrival, non reacting pupils, low hemoglobin, high random blood sugar, high creatinine and intubation on arrival are associated with increased mortality. Associated skull bone fractures, cerebral infarct, diffuse brain edema are predictors of poor outcome. Anticoagulants and associated co-morbidities do not increase the risk of mortality in traumatic brain injury in elderly.

Analysis of Roadside Accident Severity on Rural and Urban Roadways

The differences in traffic accident severity between urban and rural areas have been widely studied, but conclusions are still limited. To explore the factors influencing the occurrence of roadside accidents in urban and rural areas, 3735 roadside traffic accidents from 2017 to 2019 were analyzed. Fourteen variables from the aspects of driver, vehicle, driving environment, and other influencing factors were selected to establish a Bayesian binary logit model of roadside crashes. The deviance information criterion and receiver operating characteristic curve were used to test the goodness of fit for the traffic crash model. The results show that: (1) the Bayesian binary logit regression model well fits the traffic crash data, and the goodness of fit for sub-models based on separate urban and rural data is better than when based on all data (urban and rural); (2) 10 variables have a significant influence on the extent of roadside crash severity in the two areas, with different impacts; (3) drunk driving increases the probabilities of fatal traffic accidents by 10.8% and 16.4% in urban and rural areas, respectively; (4) the probabilities of fatality caused by traffic accidents involving trucks are 4.6% and 9.8% higher than those without trucks in urban and rural areas, respectively. The findings of this study can provide a theoretical foundation for traffic safety administration to formulate relevant policies or strategies in order to reduce the severity of roadside accidents.

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

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.