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Background and Aims Introduction Regional anesthesia provides a safe and efficient alternative anesthetic management modality in cases with high aerosol transmission risks and post operative pulmonary complications. This case describes the anesthetic management of emergency left thumb amputation on a patient with active lung tuberculosis and spontaneous pneumothorax.

Methods Case illustration A 26-year-old woman presented to the emergency room with increasing dyspnea and yellowish-white and bloody discharge from a huge mass on her left thumb. Patient was diagnosed with spontaneous pneumothorax, lung tuberculosis diagnosed 6 days prior, and infection of primary bone tumor on her left thumb. Placement of chest tube was followed by amputation of left thumb using a mid-arm tourniquet. An ultrasound-guided axillary brachial plexus and intercostobrachial block was performed under sedation with targeted controlled infusion (TCI) Propofol.

Results Discussion General anesthesia for elective surgeries in patients with active lung tuberculosis is recommended to be postponed until 2 weeks post anti-tuberculosis treatment. This case necessitated emergency amputation for source control and peripheral nerve block was effective in preventing aerosol contamination without requiring airway instrumentation for general anesthesia nor positive pressure ventilation that could have increased the patient’s risk for recurrent pneumothorax. In addition to conventional axillary brachial plexus block, intercostobrachial nerve block was performed for adequate anesthesia because of the tourniquet use.

Conclusions Conclusion Regional anesthesia is a reliable modality for patients and healthcare personnel in cases with high risks of infectious aerosol transmission. The additional intercostbrachialis block enabled anesthesia coverage of the medial upper arm due tourniquet use.