Background and Aims We report an axillary branchial plexus block for surgical anaesthesia in a third-trimester parturient without other comorbidities. The 30-year-old woman (34 weeks) was scheduled for external fixation of her Colles’ fracture (left) after a ground-level fall. The patient consented to the proposed awake regional block technique instead of general anaesthesia.
Methods We performed a multiple-injection peripheral nerve stimulation (PNS) technique with 0.5% ropivacaine 30 mL, 1% lidocaine 10 mL, with 1:400.000 epinephrine as intravascular marker. The patient was placed in left lateral decubitus position with the arm to be blocked placed at a right angle to the body and the elbow flexed to 90 degrees. Skin anesthesia was also applied for the placement of an arm tourniquet. Standard monitoring was placed, supplemental oxygen was administered, baseline fetal heart rate was obtained by our obstetrical colleague. No sedatives or analgesics were administered during either procedure.
Results Our block was well tolerated and produced reliable and adequate anaesthesia during the 50-minute surgical procedure. No respiratory compromise was observed. The block lasted approximately 10h and no pain was reported for 6h. In post-anaesthesia care unit, she had normal respiration, she did not complain about pain, and our obstetric colleagues reassessed the fetal heart rate without any new concerns. The patient was discharged the next day.
Conclusions We successfully performed adequate regional anaesthesia, using a reliable and safe technique, avoiding hemidiaphragm paralysis. This non-obstetric surgery in the parturient amplified the necessity of neuraxial anaesthesia, as branchial plexus block can be ideal for upper extremity pathology.