Article Text
PDF
Abstract
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 describe Surgery specific regional anaesthesia(SSpecRA), as the term/concept in which according to the diagnosis and planned surgery, a regional anaesthetic technique is planned for surgical anaesthesia comforting the patient and reducing the risk associated with blocking unwanted structures, on one hand reducing complications and on the other hand preventing conversion to general anesthesia in high risk patients(table 2). The nerves to be blocked for a particular surgery should be analyzed and tailored to be done exclusively under regional anesthesia.We analysed for clavicle fixation[table 1].
Methods A 51y old male massively obese(BMI-52.14kg/m2) with OSA was posted for open reduction and internal fixation of the closed/displaced fracture of left clavicle. Ultrasound guided left superior and middle trunk brachial plexus block(SMTBPB) with left superficial cervical plexus block(SCPB) was administered. 5 ml of LA mixture given around superior trunk and 5ml around middle trunk just before its division into anterior and posterior. Left SCPB administered with 10ml of LA mixture. LA mixture is prepared by 10ml of 2% lignocaine with adrenaline(1: 200,000) and 10ml of 0.5%bupivacaine.Multiple measures taken to prevent phrenic nerve blockade.
Results Surgery was done successfully under regional anesthesia without need for conversion to GA. Intra operatively patient was comfortable. He did not have symptomatic dyspnoea or desaturation(phrenic nerve), Horner’s syndrome(sympathetic chain) or hoarseness of voice (recurrent laryngeal palsy).
Conclusions Surgery specific regional anesthesia for clavicle surgery, spares phrenic nerve ensuring clavicle surgery only under regional anesthesia, in high risk patients(massively obese), who otherwise may not tolerate diaphragmatic palsy secondary to regional anaesthesia
End of surgery, the skin area anesthetised after the SMTBPB and SCPB block is marked. A - Anteroposterior View. B- Lateral View
Tabulation of the nerve supply and root values of the structures to be blocked for surgical anaesthesia and regional anaesthesia targets for plate fixation of the clavicle. [1, 2]
Surgery specific regional anesthesia (SSpecRA) -prerequisites, planning and execution