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167 Ultrasound guided costoclavicular brachial plexus block for proximal humerus fracture with pneumothorax in an elderly patient – a case report
  1. A Baskaran,
  2. G P,
  3. S D and
  4. B J
  1. Ganga Medical Centre and Hospitals pvt ltd, Coimbatore, India


Background and Aims Patients with proximal humeral fractures present a unique challenge to anesthesiologists because no single brachial plexus block adequately covers the entire distribution of the upper extremity. It is more complicated in the presence of multiple trauma with rib fractures and pneumothorax.

Methods We report a case of 70 year old male,ASA II admitted with polytrauma. Radiological investigations revealed closed fracture of right humerus and right distal radius with left sided mild pneumothorax following multiple left sided rib fractures and was scheduled for right humerus plating along with bone grafting and closed reduction of right distal radius. Inside operation theatre, standard monitors were attached and oxygen support was provided. Under sterile aseptic precautions, patient in supine position, a linear array Ultrasound probe (5–13MHz, Sonosite, USA) was used. Under Ultrasound guidance, 21G,1.5inch needle was inserted in-plane approach. Right Costoclavicular block was given with 15 ml of 0.75% Ropivacaine with 8 mg Inj. Dexamethasone and subcutaneous infiltration of 10 ml of 2% lignocaine with adrenaline for the blockade of intercostobrachial nerve and posterior cutaneous nerve of arm.

Results Costoclavicular block is also effective in the blockade of upper trunk of brachial plexus due to chimney effect. In the infraclavicular region, the neurovascular plexus sheath forms longitudinal septae between the cords that limits the circumferential spread of local anesthetics resulting in sparing of phrenic nerve. The success of anesthetic block is higher with multiple injections compared to single injection technique.

Conclusions Costoclavicular block is safer alternative for upper limb surgeries in case of polytrauma with compromised lung function.

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