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208 Distal nerve blocks for upper limb surgery: high quality, low volumes
  1. C Lopes,
  2. D Zuzarte and
  3. M Chedas
  1. Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal


Background and Aims Through this clinical case we aim to raise awareness of the existence of highly effective peripheral nerve blocks that allow to minimize the volume of local anesthetic, thus reducing the associated complications.

Methods A 20 year-old ASA I man was admitted for urgent reconstructive plastic surgery after left hand flexor tendon injury and right forearm extensor digitorium injury.

To offer anesthesia of the whole hand, we decided to perform a left axillary block. The right-limb wound was expected to be superficial and thus manageable under subcutaneous anesthetic infiltration.

When initiating the intervention on the right wound it was obvious that subcutaneous anesthesia was insufficient as the injury was deeper than predicted.

Faced with the fact that we had almost reached the toxic dose and that we were avoiding approaching the airway, we decided to perform an ultrasound guided distal-arm radial block, as the involved structures depended on radial sensory innervation.

Results A total amount of 3 ml of local anesthetic was used.

The patient experienced complete anesthesia of the radial nerve territory, and surgery was successfully achieved. No complications were reported

Conclusions This approach reminds us that that, similar to the distal-arm radial block, there are numerous distal blocks that can be performed. While allowing a volume sparing technique, these blocks are both easy and safe to perform, offering high quality anesthesia and analgesia.

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