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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.
AuthorsBrian Gelpi, Pavan R Telang, Christian G Samuelson, Craig S Hamilton, Seth Billiodeaux
JournalThe Journal of the Louisiana State Medical Society : official organ of the Louisiana State Medical Society (J La State Med Soc) 2014 Mar-Apr Vol. 166 Issue 2 Pg. 60-2 ISSN: 0024-6921 [Print] United States
PMID25075596 (Publication Type: Case Reports, Journal Article)
Topics
  • Adult
  • Amputation, Surgical
  • Brachial Plexus Block (methods)
  • Electric Injuries (diagnostic imaging, physiopathology, surgery)
  • Humans
  • Male
  • Pain, Postoperative (diagnostic imaging, physiopathology, therapy)
  • Phrenic Nerve (diagnostic imaging, physiopathology)
  • Upper Extremity (diagnostic imaging, injuries, innervation)

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