Vol 5 | Issue 2 | July-December 2024 | Page 27-30 | Anupama Triparhi Srikanth, Pooja Patil, Anitha Pramod, Srikanth V
DOI: https://doi.org/10.13107/ijra.2024.v05.i02.104
Open Access License: CC BY-NC 4.0
Copyright Statement: Copyright © 2024; The Author(s).
Submitted: February 10-07-2024; Reviewed: 02-08-2024; Accepted: 03-10-2024; Published: 10-12-2024
Authors: Anupama Triparhi Srikanth [1], Pooja Patil [1], Anitha Pramod [1], Srikanth V [1]
[1] Department of Anaesthesiology, Manipal Hospitals, Old airport road, Bangalore, Karnataka, India.
Address of Correspondence
Dr. Pooja Patil
Department of Anaesthesiology, Manipal Hospitals, Old airport road, Bangalore, Karnataka, India.
Email id: patil24992pooja@gmail.com
Abstract
Background: Performing bilateral brachial plexus blocks (BPB) in paediatric patients is a rare practice due to concerns like diaphragmatic paralysis, local anaesthetic systemic toxicity, pneumothorax and hematoma formation. The introduction of ultrasound in regional anaesthesia has revolutionized precision, allowing reduced local anaesthetic doses and increased success rates.
Case Description: We present the case of an 11-year-old male, who underwent uneventful surgical repair for Tetralogy of Fallot at 8 months of age, posted for right index finger pollicization and left-hand distractor frame application. Auscultatory finding of loud S2 and ejection systolic murmur corroborated with echo finding of mild pulmonary regurgitation, intact VSD patch, and good biventricular function. After administering general anaesthesia with controlled ventilation, ultrasound-guided axillary approach bilateral BPB with 11 ml 0.33% Ropivacaine (equal volume mixture of 0.5% and 0.2% Ropivacaine after calculation of maximum allowable dose) was given sequentially on each side with an interval of 2.5 hours. The overall outcome was safe and uneventful.
Discussion: According to the Pediatric Regional Anaesthesia Network, only 3% of all regional anaesthetics (RA) in children involve upper limb blocks. Literature supporting bilateral BPB in children is scarce. RA improves haemodynamic stability, reduces the incidence of postoperative respiratory complications, decreases catecholamine production and the metabolic stress response to surgery and promotes a fast return of gut function and feeding, all of which benefited this child with known cardiac comorbidity. Improvement in the accuracy of ultrasound imaging has undoubtedly boosted regional anaesthetic techniques making nerve blocks safe and well tolerated in children.
Conclusion: Our case report demonstrates successful incorporation of US guided bilateral axillary brachial plexus block in a child with preexisting cardiac illness coming for major upper limb surgeries resulting in a painfree child, satisfied parents and happy surgeons.
Keywords: Bilateral brachial plexus blocks (BPB), Pediatric Regional Anaesthesia, Ultrasound.
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| How to Cite this Article: Srikanth AT, Patil P, Pramod A, V Srikanth | A Case Report on Bilateral Ultrasound Guided Brachial Plexus Block in a Paediatric Patient with Unusual Congenital Anomalies | International Journal of Regional Anaesthesia | July-December 2024; 5(2): 27-30 | DOI: https://doi.org/10.13107/ijra.2024.v05.i02.104 |
