Concurrent Open Reduction and Fixation of the Femur and Humerus under Spinal and Ultrasound-guided Interscalene Catheter Anaesthesia in a Cachectic Patient on Haemodialysis

Abstract

Purpose: We describe a complex medical case in which an ultrasound-guided interscalene brachial plexus block (ISBPB) was used with continuous perineural infusion and concomitant spinal anaesthesia for surgical anaesthesia and postoperative analgesia in a patient with multiple comorbidities , who required repair of multiple long bone fractures. Materials and methods:The current case report is presented with patient consent and with Institutional Research Ethics Board approval. Results:A 53-year-old female patient with multiple medical comorbidities suffered a fall as a result of a hypoglycemic epi sodeandpresentedforopenreductionandinternalfixation of distal femur fracture and revision of the fractured contralateral proximal humerus. This case was one of complex surgical anaes thesia and analgesia as a result of the patient's significantcomorbiditiesincludingtypeIdiabetes,end-stagerenal disease, peripheral vascular disease, hypertension, severe kyphosis,anaemia,hypothyroidism,gastroesophagealreflux disease, chronic cough, chronic steroid use and multiple phar ma cological sensitivities. The use of an ISBPB using an in-dwelling perineural catheter and concomitant spinal anaesthesia provided appropriate surgical anaesthesia and post-operative analgesia. Conclusion:Our case illustrates the success of an ISBPB with continuous perineural infusion with concurrent spinal anaesthesia for surgical anaesthesia and postoperative analgesia in a patientwithsignificantmedicalcomorbiditiespresentingwith two long bone fractures.