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ESRA19-0666 Successful upper extremity surgery in tetanus patient with trismus performed under ultrasound-guided supraclavicular brachial plexus block: a case report
  1. HK Chandra,
  2. DR Basuki,
  3. RM Laksono,
  4. TA Siswagama,
  5. AA Asmoro and
  6. R Vitraludyono
  1. Brawijaya University, Anesthesia and Intensive Therapy, Malang, Indonesia


Background and aims Tetanus is an acute, often fatal, disease caused by exotoxin produced by the bacterium Clostridium tetani which characterized by muscle rigidity, autonomic instability, and sometimes convulsions.1 Increased masseter tone (trismus) occurs in 50–75% tetanus patients.2 Brachial plexus blockade provides avoidance of airway instrumentation, decreased hemodynamic instability, and intra-, as well as post-operative analgesia.3 4 the aim of this study is to report case of minimal airway interference during upper extremity surgery in tetanus patient with trismus using ultrasound-guided supraclavicular brachial plexus block anesthesia.

Methods A 43-year-old male patient diagnosed with moderate tetanus with trismus scheduled for external fixation of neglected fracture distal radius-ulna. He presented with 1-cm mouth opening and intermittent spasm of neck, stomach, and extremities. Past history revealed intermittent seizure after he fell from a tree approximately 10 days prior. Surgical procedure was performed under ultrasound-guided supraclavicular brachial plexus block using Naropin 0,75% 20 cc.

Results We had successful supraclavicular brachial plexus block anesthesia technique for external fixation surgery in non-intubated tetanus patient with trismus, guided by ultrasound device. Post-operative analgesia considered satisifying, with 2/10 Wong Baker Faces pain rating scale at 48 hours after surgery.

Abstract ESRA19-0666 Figure 1
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Conclusions Supraclavicular brachial plexus block provides safe anesthesia technique for upper extremity surgery in tetanus patient with trismus and has good post-operative outcomes. This regional anesthesia can be used to patient with possibility of difficult intubation such in this case. It also has minimal risk of aspiration, laryngeal spasm, and reduced harmful effect caused by systemic anesthetic agent.

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