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B254 Ultrasound guided continuous supraclavicular brachial plexus block using an intravenous cannula for post-traumatic finger reimplantation: a case report
  1. R Joshi1,
  2. R Jeevan1,
  3. J Ramesh1 and
  4. A Basheer2
  1. 1Saveetha Medical College Hospital, Chennai, India
  2. 2Regional Cancer Centre, Thiruvananthapuram, India


Background and Aims Continuous blockade of brachial plexus at the Supraclavicular level, for prolonged elbow and hand surgeries, is usually achieved by using catheters. But these are costly. A cost effective method would be intravenous cannulae.

Methods A 47 year-old ASA I male patient, was scheduled for finger re-implantation for traumatic loss of middle three fingers. He had lower respiratory tract infection. Patient refused for surgery under general anesthesia. He received premedication with Midazolam 1 mg and Fentanyl 30 microgram IV. Under ultrasound guidance, continuous supraclavicular brachial plexus block was performed using an intravenous cannula since patient could not afford a catheter. After 2% lignocaine infiltration, a 16 G IV cannula needle was inserted in-plane from lateral to medial direction and advanced to pierce sheath posterior to brachial plexus. The tip was positioned at the corner pocket and, 10 ml 2% Lignocaine with adrenaline, 10 ml 0.25% Bupivacaine and 4 mg Dexamethasone was slowly injected after intermittent negative aspiration. The cannula sheath was kept in situ. Intraoperatively Dexmeditomidine infusion was started. Injection 0.25% Bupivacaine 10 ml was repeated after 4 hours and 8 hours through the cannula.

Results Surgery lasted for 10 hours in supine position. Supraclavicular nerve block cannula was removed immediately after surgery. Postoperatively patient was on Paracetamol 1 gm IV Q8H. Patient was pain free throughout and postoperatively upto 6 hours.

Conclusions Intravenous cannula is a cost-effective, readily available and time saving alternative to catheter. It might be considered intraoperatively for continuous supraclavicular brachial plexus block in prolonged upper limb surgeries.

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