Continuous Bilateral Brachial Plexus Blockade for Acute Pain Control in Patients with Bilateral Upper Extremity Traumatic Injuries: A Review of Five Cases

Abstract

Study objective: Brachial plexus catheters are typically placed to provide regional anesthesia to the shoulder, arm, forearm, wrist and hand. However, there are risks associated with catheter placement including infection and local anesthetic toxicity. Study design:In this study we discuss five case scenarios where we felt bilateral brachial plexus blocks were appropriate and, if performed with caution, the benefits would outweigh the risks. Each of these patients suffered severe bilateral upper-extremity traumatic injuries, requiring multiple surgical procedures and debridement's while inpatient on the trauma service. These patients were chosen because of the need for pain control during their hospital stay, the appropriateness of these particular techniques, and a lack of absolute contraindications to these techniques. Conclusions:In carefully-selected patients, bilateral brachial plexus catheters can be used safely and effectively to control pain secondary to traumatic injuries to the upper extremities. These catheters are a potentially valuable tool as part of a multimodal pain control regimen, with the goal of achieving adequate pain management, while limiting opioid use.

<p>Bilateral Brachial Plexus Block Using Chloroprocaine For Surgery Of Bilateral Radial Fractures</p>

“…In the approach below the cricoid cartilage, the phrenic nerve block depends on the administered volume 3. Sen et al reported a case series of continuous bilateral brachial plexus block without complications 4. Phrenic nerve palsy can occur with infraclavicular block (25%) but much less frequently than supraclavicular (50%) and interscalene block (100%) 5…”

Effects of adding dexmedetomidine, fentanyl, and verapamil to 0.5% ropivacaine on onset and duration of sensory and motor block in forearm surgeries

“…1 2 A local block reduces the risks with general anesthesia which may be allied with adverse events, even death, in some patients while creating surgical conditions and faster patient mobility postoperatively, and besides diminishes hospital-associated costs. 3 4 Axillary plexus block is frequently employed for anesthesia in hand and forearm surgeries. 5 …”