title: The anesthetic considerations while performing supraclavicular brachial plexus block in emergency surgical patients using a nerve stimulator.
abstract: Regional anesthesia is favored in patients who undergo emergency extremity (limb) surgery, and specifically so in the absence of fasting status. In the absence of ultrasonic guidance, the nerve stimulator still remains a valuable tool in performing a brachial block, but its use is difficult in an emergency surgical patient and greater cautious approach is essential. We identified the supraclavicular plexus by the nerve stimulation-motor response technique as follows. Anterior chest muscles contractions, diaphragmatic contraction, deltoid contractions, and posterior shoulder girdle muscle contractions when identified were taken as "negative response" with decreasing stimulating current. A forearm muscle contraction, especially "wrist flexion" and "finger flexion" at 0.5 mA of current was taken as "positive response." If no positive response was identified, the "elbow flexion" was considered as the final positive response for successful drug placement. The series of patients had difficulty for administering both general and regional anesthesia and we considered them as complex scenarios. The risk of the block failure was weighed heavily against the benefits of its success. The described series includes patients who had successful outcomes in the end and the techniques, merits, and risks are highlighted.
authors.affiliation: Department of Anaesthesiology, A J Institute of Medical Sciences, Kuntikana, Mangalore, Karnataka, India.
authors.forename: Thrivikrama Padur
authors.initials: TP
authors.lastname: Tantry
authors.affiliation: Department of Anaesthesiology, A J Institute of Medical Sciences, Kuntikana, Mangalore, Karnataka, India.
authors.forename: Pramal
authors.initials: P
authors.lastname: Shetty
authors.affiliation: Department of Anaesthesiology, A J Institute of Medical Sciences, Kuntikana, Mangalore, Karnataka, India.
authors.forename: Rithesh
authors.initials: R
authors.lastname: Shetty
authors.affiliation: Department of Urology, A J Institute of Medical Sciences, Kuntikana, Mangalore, Karnataka, India.
authors.forename: Sunil P
authors.initials: SP
authors.lastname: Shenoy
keywords: Brachial block; emergency surgery; motor response; nerve stimulation; nerve stimulator; supraclavicular; upper limb