Color Doppler Ultrasound-guided Axillary Brachial Plexus Block in Patient without Brachial Pulse: A Case Report
AbstractColor Doppler ultrasound-guided regional block like brachial plexus block lately changed other anesthesia and analgesia practice because of the accuracy and simplicity of practice to view the anatomy of blood vessels and nerves. With color Doppler ultrasound-guided regional block you can follow needle track to nerves and prevent any vessel puncture. It can be the standard for any regional block. The patient was a 64 years Iranian who had diabetes mellitus and hypertension and planned as an urgent right upper limb amputation surgery. Because of the acute exacerbation of COPD due to pneumonia we decided to use regional anesthesia for this patient. On the first physical examination there was no peripheral pulse in patient’s right hand. With ultra-sonographic color Doppler the pulselessness of right hand artery were monitored. With the anatomic and awareness of grey-scaled ultrasonography the nerves and vessels were found. Axillary brachial plexus block with guidance of grey-scaled ultrasonography were done and the surgery was successfully performed and patient transferred to ICU for post operation care after surgery.
Sites BD, Brull R, Chan VW, Spence BC, Gallagher J, Beach ML, et al. Artifacts and pitfall errors associated with ultrasound-guided regional anesthesia. Part II: a pictorial approach to understanding and avoidance. Reg Anesth Pain Med.2010; 35(Suppl 1):S81–92.
Sites BD, Macfarlane AJ, Sites VR, Naraghi AM, Chan VW, Antonakakis JG, et al. Clinical Sonopathology for the regional anesthesiologist: part 1: vascular and neural. Reg Anesth Pain Med. 2010; 35(3):272–80.
Kinjo S, Frankel A. Failure of supraclavicular block under ultrasound guidance: clinical relevance of anatomical variation of cervical vessels. J Anesth. 2012; 26(1):100-2.
Cox B, Durieux ME, Marcus MA. Toxicity of local anaesthetics. Best Pract Res Clin Anaesthesiol. 2003; 17(1):111–36.
LiguoriGA. Complications of regional anesthesia: nerve injury and peripheral neural blockade. J Neurosurg Anesthesiol. 2004;16(1):84-6.
Muhly WT, Orebaugh SL. Sonoanatomy of the vasculature at the supraclavicular and interscalene regions relevant for brachial plexus block. Acta Anaesthesiol Scand. 2011; 55(10):1247-53.