Above Elbow Amputation Under Brachial Plexus Block at Supraclavicular and Interscalene Levels

Abstract

Introduction:The brachial plexus block is a commonly performed procedure in the anesthetic practice today. It is performed for analgesia as well as anesthesia for upper limb procedures. It has been used for amputation and replantation surgeries of the upper limb.Case presentation:We present the case of a 68-year-old gentleman who had brachial plexus block at supraclavicular and interscalene levels as the sole anesthetic for undergoing above elbow amputation. He was deemed to be very high risk for a general anesthetic as he suffered from severe chronic obstructive pulmonary disease (COPD) and a very poor exercise tolerance (NYHA Class III). The supraclavicular brachial plexus block was supplemented with an interscalene brachial plexus block due to inadequate surgical anesthesia encountered with the former. The procedure was successfully completed under regional anesthesia.Conclusions:The brachial plexus block can be performed at different levels in the same patient to achieve desired results, while employing sound anatomical knowledge and adhering to the maximum safe dose limit of the local anesthetic.

Combined interscalene and supraclavicular brachial plexus block using ultrasound guidance versus general anaesthesia for brachioaxillary graft in patients with chronic renal failure

“…20 To our knowledge, only few studies have discussed combined SCB and ISBusage. 1,16,20 Our study is the first to describe this combined block in patients with CRF.…”

“…Brachial plexus block (BPB)using ultrasound guidance is routinely used for upper limb anaesthesia and analgesia. 1 BPB has many approaches depending upon the area to be anaesthetized in the upper limb. The interscalene block (ISB) covers the lateral two thirds of the clavicle, proximal humerus and the shoulder.…”