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Abstract
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Background and Aims Orthopedic surgeons routinely use mechanical tourniquets in upper limb surgery, which can disrupt normal physiology and lead to complications. Patients with cardiac comorbidities, neuropathy or vascular disease, may not tolerated these changes. We introduce a novel approach that combines regional anesthesia with targeted vasoconstriction to minimize complications, while ensuring bloodless surgical field.
Methods The novel technique of locoregional anesthesia combines WALANT and PVI principles. Our method involves administering a local anesthetic via axillary block with 20ml 0,5% ropivacaine. In order to achieve a bloodless surgical field, we then employ ultrasound guidance to inject small volumes of a vasoconstrictor mixture around specific vascular structures supplying the ulnar medulla, its cortex, and the incision site.
Results We used the technique in a case involving a 56-year-old male with significant comorbidities, including dilated cardiomyopathy with an ejection fraction of 13%, scheduled for emergency surgery for a midshaft ulna fracture. With this technique, we achieved pain relief, and using a total of 35ml of the vasoconstrictor mixture, we also guaranteed a bloodless surgical field and a total blood loss of 15ml.
Conclusions Utilizing locoregional anesthesia and a targeted chemical tourniquet technique, we achieved a near-bloodless surgical field without requiring general anesthesia, sedation, or a mechanical tourniquet, thereby reducing potential risks associated with conventional methods.This approach may provide numerous advantages, such as enhanced patient recovery, reduced postoperative complications, shorter hospital stays and decreased costs.
X-ray of Ulna
Incision during surgery
Fracture shown
Attachment Total bloodloss.jpg