title: Bilateral ultrasound-guided supraclavicular block in a patient with severe electrocution injuries of the upper extremities.
abstract: The performance of bilateral supraclavicular brachial plexus nerve blocks is controversial. We present the challenging case of a 29-year-old male who suffered bilateral high-voltage electrocution injuries to the upper extremities, resulting in severe tissue damage, sensory and motor deficits, and wounds in both axillae. This injury necessitated bilateral below-elbow amputations. His postoperative course was complicated by pain refractory to intravenous narcotics. The decision was made to attempt bilateral supraclavicular brachial plexus blocks. Our concerns with this approach included the risks of pneumothorax and respiratory failure due to phrenic nerve block. Initial attempts at brachial plexus blockade using nerve stimulation were unsuccessful; therefore, ultrasound guidance was employed. With vigilant monitoring in an intensive care unit setting, we were able to safely perform bilateral continuous supraclavicular brachial plexus nerve blocks with an excellent analgesic response and no noted complications.
authors: Final-year Resident with the Department of Anesthesiology at Louisiana State University Health Sciences Center in Shreveport.
authors: Brian
authors: B
authors: Gelpi
authors: Pain Management Specialist with Alabama Spine and Pain and a former Pain Medicine Fellow with the Department of Anesthesiology at LSUHSC-Shreveport.
authors: Pavan R
authors: PR
authors: Telang
authors: Resident with the Department of Anesthesiology at LSUHSC-Shreveport.
authors: Christian G
authors: CG
authors: Samuelson
authors: Clinical Research Associate at LSUHSC-Shreveport.
authors: Craig S
authors: CS
authors: Hamilton
authors: Pain Management Specialist with Lake Charles Memorial Health System and a former member of Faculty in the Department of Anesthesiology at LSUHSC-Shreveport.
authors: Seth
authors: S
authors: Billiodeaux
mesh_terms: D000328:Adult; D000671:Amputation, Surgical; D065527:Brachial Plexus Block / Q000379:methods*; D004556:Electric Injuries / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D008297:Male; D010149:Postoperative Pain / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy; D010791:Phrenic Nerve / Q000000981:diagnostic imaging / Q000503:physiopathology; D034941:Upper Extremity / Q000000981:diagnostic imaging / Q000293:injuries / Q000294:innervation