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Background and Aims A 75 year old male presented to hospital with traumatic injuries after falling down stairs. He sustained multiple rib fractures, facial fractures and bilateral displaced radial fractures. The patient developed pulmonary contusions and rib fracture pain was managed with multimodal analgesia including an erector spinae plane catheter. He was listed for bilateral distal radial open reduction and internal fixation (ORIF) by trauma surgical team.
Methods Bilateral infraclavicular brachial plexus block performed whilst patient awake in supine position using an 80mm needle in plane with real time ultrasound. Total of 40 ml of 0.375% Bupivacaine used. Sedation was achieved with Propofol target controlled infusion and boluses of midazolam and ketamine. No airway intervention was required, the patient breathed spontaneously throughout.
Results Right and left distal radial ORIF were performed simultaneously with separate surgical teams with pneumatic tourniquets on each arm.
Conclusions In our experience anaesthetists would be hesitant to perform bilateral brachial plexus blocks due to concerns regarding inadvertent phrenic nerve block, local anaesthetic toxicity and perceived patient discomfort with bilateral motor block. We carefully calculated local anaesthesia doses for two blocks as well as considering the contribution of bupivacaine from the erector spinae plane catheter. Ultrasound guided infraclavicular block allowed us to reduce risk of phrenic nerve embarrassment and perform the block comfortably in a supine position with minimal patient movement. In this case regional anaesthesia avoided the perioperative risks of a general anaesthesia in a patient with significant chest trauma, the patient recovered well post-operatively.