Ultrasound-Guided Interscalene Brachial Plexus Block for Pathological Humerus Fracture due to Multiple Myeloma with Systemic Manifestation: Useful Option for Management in Low-Income Countries

Anesthetic management of pathological fracture due to multiple myeloma with systemic manifestation poses a perioperative challenge especially in low-resource setups like Nepal. Regional anesthesia using ultrasound-guided block can improve the accuracy, reduce complications, and improve overall perioperative management of pathological fractures due to malignancy with systemic spread in resource-deprived setups. We present a case of a 53-year-old lady with pathological fracture of left humerus shaft, a diagnosed case of multiple myeloma with compression fracture of multiple lumbar spine with chest wall metastasis with resolving acute kidney injury with chest infections. Ultrasound-guided interscalene brachial plexus block with sedation was done for open reduction internal fixation of humerus shaft fracture taking in consideration the overall high perioperative risk of patient. Intraoperative hemodynamic was uneventful, with no neurological sequelae and good recovery status perioperatively. Ultrasound-guided interscalene brachial plexus block if done cautiously can be a very useful alternative technique for better perioperative outcome in patients with malignancy with systemic spread in areas where expertise is scarce and resource is limited.

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Ultrasound-Guided Interscalene Brachial Plexus Block in a Patient With a Ventriculoperitoneal Shunt

Regional Anesthesia and Pain Medicine ◽

10.1016/j.rapm.2007.04.012 ◽

2008 ◽

Vol 33 (3) ◽

pp. 273-274

Author(s):

C ROBARDS ◽

T IWATA ◽

L SOMASUNDARAM ◽

D XU ◽

A HADZIC

Keyword(s):

Brachial Plexus ◽

Ventriculoperitoneal Shunt ◽

Brachial Plexus Block ◽

Ultrasound Guided ◽

Interscalene Brachial Plexus Block ◽

Plexus Block

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Ultrasound guided interscalene brachial plexus block via lower approach for upper limb surgeries

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20183913 ◽

2018 ◽

Vol 5 (5) ◽

pp. 1304

Author(s):

Roopal R. Garaniya ◽

Sheetal Shah ◽

Noopur Prajapati

Keyword(s):

Peripheral Nerve ◽

Brachial Plexus ◽

Ulnar Nerve ◽

Upper Limb ◽

Brachial Plexus Block ◽

Interscalene Block ◽

Ultrasound Guided ◽

Peripheral Nerve Stimulator ◽

Interscalene Brachial Plexus Block ◽

Plexus Block

Background: Brachial plexus block via interscalene approach is an excellent option for upper limb surgeries, but due to sparing of ulnar nerve (lower trunk, C8-T1) and its’ complications, it is not so popular. To overcome this problem, interscalene block via lower approach has been tried which has more advantage in view of ulnar nerve blockage and also less complications. In addition, ultrasound provides reliability, ease, rapidity and also patient comfort during block procedure. This prospective study was performed to evaluate the anaesthetic effect of lower approach interscalene block with the help of ultrasound and peripheral nerve stimulator.Methods: Ultrasound guided interscalene brachial plexus block via lower approach was given in randomly selected 30 patients, undergoing upper limb orthopaedic surgeries. After localisation of brachial plexus with ultrasound, the nerve roots were confirmed with the help of peripheral nerve stimulator, before injecting drug. At 5 and 15 min after block, all patients were assessed for the effect. Postoperatively they were assessed for any complication and also for their satisfaction level by Likert’s scale.Results: In territories of ulnar, radial and musculocutaneous nerve there was 100% effect while in median nerve territory 92.8% motor block was there. There was no need of analgesics during intra operative period in any patient and there were no major complications with this approach.Conclusions: Ultrasound guided interscalene block via lower approach is an excellent alternative for upper limb surgeries over classical approach in view of ulnar nerve blockage without any major complication.

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