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Background and Aims Upper extremity surgeries are generally performed under general anaesthesia, regional anaesthesia or a combination of both. However, with the advent of newer techniques of administering peripheral nerve blocks using ultrasound, the need and use of general anaesthesia in upper limb surgeries is declining, where these facilities are available. In patients with anticipated difficult airway and medical comorbidities, this state of art technique proves to be even more safe, precise and reliable as a mode of anaesthesia.
Methods This case study includes a 62 year male patient with a fracture of shaft of humerus requiring open reduction and internal fixation. He was a chronic smoker and alcoholic. On airway examination, he was found to have no neck movements due to trauma to cervical spine during childhood. We proceeded with ultrasound guided inter scalene and supraclavicular block with a total of 20 ml of 0.75% ropivacaine and 4mg of dexamethasone. The difficult airway cart and awake fibre optic intubation equipments were kept as standby.
Results The surgery was completed solely under the nerve block without requiring any additional analgesic or rescue anaesthesia. The patient remained pain free in the postoperative period and was discharged the next day.
Conclusions Ultrasound guided regional anaesthesia proves to be a boon in high risk upper limb trauma cases. It circumvents the need of airway manipulation in anticipated difficult airway cases and also eliminates the cardiopulmonary effects of general anaesthesia in medically compromised patients.