Local and Regional Anesthesia (Sep 2019)
Bilateral Brachial Plexus Block Using Chloroprocaine For Surgery Of Bilateral Radial Fractures
Abstract
Chanchal Mangla, Hattiyangadi Sangeetha Kamath, Joel Yarmush Department of Anesthesiology, New York Presbytarian Brooklyn Methodist Hospital, New York, NY, USACorrespondence: Chanchal ManglaDepartment of Anesthesiology, New York Presbyarian Brooklyn Methodist Hospital, 506 Sixth Street, Brooklyn, New York, NY, USATel +1 718 780 3270Email [email protected]: We report a case of a 41-year-old male with anticipated difficult airway undergoing a repair of a bilateral radial fracture under bilateral sequential brachial plexus block. Anesthesiologists are reluctant to perform bilateral blocks because of the fear of complications like diaphragmatic paralysis, local anesthetic (LA) toxicity, and pneumothorax. We advise that with the correct application of LA pharmacokinetics, careful patient selection and usage of ultrasound, bilateral blocks can be done safely. We used chloroprocaine as an LA in one of the blocks to reduce the dose required for the more toxic LAs. chloroprocaine’s fast metabolism also helped us to prevent the overlapping of peak plasma concentration of different LAs. To our knowledge, this is the first reported case in the literature where chloroprocaine was used for bilateral brachial plexus block.Keywords: brachial plexus block, local anesthetics (LA), chloroprocaine
