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Abstract
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Background and Aims Osteogenesis Imperfecta (OI) is a genetically inherited disorder characterized by defects in the production of type 1 collagen, resulting in the susceptibility to spontaneous or minor trauma-related bone fractures. Patients with this condition pose major challenges in general anesthesia. We aimed to present our management of regional anesthesia in a patient with OI scheduled for surgery due to osteophyte formation in the elbow joint.
Methods A 41-year-old woman (30 kg, 110 cm) with known history of asthma, was scheduled for surgery an osteophyte in the elbow (figure 1). Due to severe restrictive lung disease, the patient carried high pulmonary risk for general anesthesia. Ultrasound and nerve stimulation guided infraclavicular brachial plexus block (IBPB) was performed using 15 mL and 5 mL of 0.375% bupivacaine for the posterior and lateral cords, respectively (figure 2). A subcutaneous injection of 5 mL of 0.2% bupivacaine was administered at the site of the tourniquet. The surgery was performed while the patient was in a wheelchair due to patient’s limitations (figure 3). Intraoperatively, the patient received 300 mg of intravenous paracetamol.
Results Adequate anesthesia and postoperative 12-hour analgesia were achieved during the 25-minute surgery.
Osteophytic lesion on the patient‘s left elbow and surgical field
Infraclavicular area and axillary artery
All equipment was repositioned due to the patient‘s position
Conclusions The supraclavicular brachial plexus block is rationale choice for elbow surgery. However, due to anatomical deformities and proximity to the lungs the IBPB was chosen. The provided postoperative analgesia prevented opioid consumption and reduced the risk of pulmonary complications in this patient. The regional anesthesia applications can improve outcomes in high risk patients like OI.
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