Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page)

Background and Aims We report a case of brachial plexus anesthesia in a twin parturient with history of epilepsy and gestational hypertension. A 40-year-old woman at 26 weeks of gestation presented in Emergency Room with a traumatic proximal right humerus fracture. She was scheduled for orthopedic surgery which was performed using a two-site ultrasound-guided brachial plexus block to maximize odds of complete anesthesia while minimizing the risk of phrenic nerve paresis.

Methods After an interscalene block with 0.5% levobupivacaine 8 mL, we translated our ultrasound probe caudally to subclavian artery. An additional injection of 0.5% levobupivacaine 12 mL was administered at this site, and the patient subsequently underwent successful surgery without sedatives or analgesics, aside from local anesthetics. Ctg monitoring was obtained during the entire procedure and any abnormalities in the fetal heart rate was recorded. In the post-anesthesia care unit, she had normal respirations and oxygen saturations breathing room air, denied any shortness of breath or difficulty breathing.

Results There is a high risk of concomitant frenic nerve blockade providing anesthesia with brachial plexus block, and for this reason we assumed, that unlike most healthy patients, a parturient would demonstrate some clinical signs and/or symptoms of hemidiaphragm paralysis, given that the diaphragm is almost totally responsible for inspiration in the term parturient.

Conclusions The most important advantage of brachial plexus block is that it allows for the avoidance of general anesthesia and the risk of any changes in systemic blood pressure and oxygenation. This represents the third brachial plexus block in a parturient