Successful Conduction of Mid-Humeral Fracture Surgery Under Ultrasound- Guided Supraclavicular Block an a Case of Cervical Scoliosis with Fixed Contracture Deformity Neck and Multiple Comorbidities

Abstract

Introduction: Regional anaesthesia has been proven lifesaver in many tough anaesthetic situations that demand good operative conditions yet are prone to put the patient under increased risk of post-operative complications including prolonged ICU stays even increasing overall mortality when general anaesthesia is chosen as primary anaesthesia modality. Use of ultrasound has revolutionised our approach to regional anaesthesia and many cases which would otherwise be deemed unfit for usual anatomy based approaches can now be conducted with enhanced precision and safety. Case presentation: We present on such case in a 69-year-old male patient with multiple high-risk factors that precluded safe conduction of general anaesthesia, with the presence of cervical scoliosis with fixed contracture neck making anatomy impossible for a blind approach to brachial plexus. Even with help of ultrasound interscalene level was not accessible due to contracture. The successful supraclavicular block was made possible as we could make a clear distinction between vessels, pleura and rib at that level although the cords appeared haphazardly placed and stretched not conforming to usual anatomy at the level. Conclusion: This case highlights the importance of regional anaesthesia under ultrasound guidance in such complex high-risk cases. As the experience with ultrasound-guided regional anaesthesia continues to grow internationally, we are on our steep learning curve appreciating the benefits and respecting the limitations of this developing technology.