[Bilateral axillary brachial plexus block guided by multiple nerve stimulation and ultrasound in a multiple trauma patient].
We present the case of a woman with multiple wounds and injuries after attempted suicide by jumping from a high place. She had multiple craniofacial injuries and fractures of both forearms requiring emergency osteosynthesis. The neurosurgeons requested that a level of consciousness be maintained for frequent assessment; therefore it was decided to provide a bilateral axillary brachial plexus block. The procedure was carried out with the aid of a nerve stimulator to locate a triple response in the left arm (radial, medial and musculocutaneous nerves) and with both ultrasound and double nerve stimulation in the right arm (medial and radial nerves). Surgery proceeded without adverse events. The location of nerves or nerve roots with both ultrasound and stimulators was highly useful in this patient in need of bilateral brachial plexus blockade. This combination, and ultrasound in particular, might be the technique of choice because it offers an image in real time and assessment of the least amount of anesthetic that seems to be needed for achieving a block.
Errando
C L
CL
Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia. c.l.errando@carloserrando.com
Pallardó
M A
MA
Herranz
A
A
Peiró
C M
CM
de Andrés
J A
JA
D000328:Adult; D001340:Autonomic Nerve Block / Q000379:methods*; D001365:Axilla; D001917:Brachial Plexus / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006259:Craniocerebral Trauma; D004558:Electric Stimulation; D004630:Emergencies; D005151:Facial Injuries; D005260:Female; D005593:Fracture Fixation, Internal; D006801:Humans; D006810:Humeral Fractures / Q000601:surgery; D008440:Maxillary Fractures; D009104:Multiple Trauma / Q000209:etiology / Q000601:surgery*; D011885:Radius Fractures / Q000601:surgery; D013406:Suicide, Attempted; D014463:Ultrasonography