title: Above Elbow Amputation Under Brachial Plexus Block at Supraclavicular and Interscalene Levels.
abstract: BACKGROUND
  The brachial plexus block is a commonly performed procedure in the anesthetic practice today. It is performed for analgesia as well as anesthesia for upper limb procedures. It has been used for amputation and replantation surgeries of the upper limb.
  
  
  METHODS
  We present the case of a 68-year-old gentleman who had brachial plexus block at supraclavicular and interscalene levels as the sole anesthetic for undergoing above elbow amputation. He was deemed to be very high risk for a general anesthetic as he suffered from severe chronic obstructive pulmonary disease (COPD) and a very poor exercise tolerance (NYHA Class III). The supraclavicular brachial plexus block was supplemented with an interscalene brachial plexus block due to inadequate surgical anesthesia encountered with the former. The procedure was successfully completed under regional anesthesia.
  
  
  CONCLUSIONS
  The brachial plexus block can be performed at different levels in the same patient to achieve desired results, while employing sound anatomical knowledge and adhering to the maximum safe dose limit of the local anesthetic.
authors.affiliation: Pennine Acute Hospitals NHS Trust, Oldham, UK.
authors.forename: Hassan
authors.initials: H
authors.lastname: Ahmad
authors.affiliation: Pennine Acute Hospitals NHS Trust, Oldham, UK.
authors.forename: Manjula
authors.initials: M
authors.lastname: Yadagiri
authors.affiliation: Pennine Acute Hospitals NHS Trust, Oldham, UK.
authors.forename: Duncan
authors.initials: D
authors.lastname: Macrosson
authors.affiliation: Tameside Hospital, Ashton-Under-Lyne, UK.
authors.forename: Amer
authors.initials: A
authors.lastname: Majeed
keywords: Anatomy; Brachial; Limit; Plexus