Role of Ultrasound-Guided Hemidiaphragm Sparing Brachial Plexus Block in the Morbidly Obese Patient
Journal of Cellular & Molecular Anesthesia,
Vol. 7 No. 4 (2022),
11 September 2022
,
Page 251-254
https://doi.org/10.22037/jcma.v7i3.38114
Abstract
Patients with Grade III obesity pose unique challenges to the treating anesthesiologists. The challenges range from difficulty in intravenous cannulation to airway management. Regional anesthesia is advantageous over general anesthesia as it avoids airway manipulation, prevents reduction in functional residual capacity, and provides good postoperative analgesia. Regional anesthesia has its pitfalls like identifying the landmarks accurately and hemi diaphragmatic palsy following brachial plexus block. Hemi diaphragmatic palsy is poorly tolerated in grade III obese patients leading to increased peri-operative morbidity which undermines the advantages of regional over general anesthesia. Ultrasound-guided costoclavicular brachial plexus block(CCBPB) has the benefit of reduced hemi diaphragmatic palsy, avoiding pleural injury, and wider distribution of sensory blockade. Costoclavicular block has been administered to obese patients in the past with great success. We are reporting a successful case of ultrasound-guided costoclavicular brachial plexus block performed in an obese patient with a BMI of 51.56Kg/m2.
- Obesity, functional residual capacity, brachial plexus block, hemi diaphragmatic palsy
How to Cite
References
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2)Şalvız EA. Regional anesthesia in adult patients with obesity. JARSS 2020;28(4):219-30.
3) Lang, Jiaxin MDa; Cui, Xulei MDa,∗; Zhang, Jia MDb; Huang, Yuguang MDa Dyspnea induced by hemidiaphragmatic paralysis after ultrasound-guided supraclavicular brachial plexus block in a morbidly obese patient, Medicine: January 14, 2022 - Volume 101 - Issue 2 - p e28525
4) Erickson JM, Louis DS, Naughton NN. Symptomatic phrenic nerve palsy after supraclavicular block in an obese man. Orthopedics 2009; 32: 368.
5) Meier, Adam W. DO; Lin, Shin-e MD; Hanson, Neil A. MD; Auyong, David B. MD A Novel Approach to Brachial Plexus Catheter Management: A Brachial Plexus Test Dose for Phrenic Nerve Paralysis and Patient-Controlled, Demand-Only Dosing for a Patient With Extreme Obesity, A & A Case Reports: September 15, 2016 - Volume 7 - Issue 6 - p 139-142
6) Sivakumar RK, Karmakar MK. How I do it: costoclavicular brachial plexus block. ASRA News 2021;46
7) Oh C, Noh C, Eom H, et al. Costoclavicular brachial plexus block reduces hemidiaphragmatic paralysis more than supraclavicular brachial plexus block: retrospective, propensity score matched cohort study. Korean J Pain. 2020;33(2):144-152.
8) Uppal, Sondekoppam, R. V., Dhir, S., Mackinnon, S. P., Kwofie, M. K., Retter, S., Lopera, L. M., Szerb, J. J., Sondekoppam Vijayashankar, R., & McKeen, D. M. (2019). Retraction Notice: Association of obesity with failure of ultrasound-guided axillary brachial plexus block: a two-centre, prospective, observational, cohort study. Anaesthesia, 75(5), 683–683.
9) Beh ZY, Hasan MS. Ultrasound-Guided Costoclavicular Approach Infraclavicular Brachial Plexus Block for Vascular Access Surgery. The Journal of Vascular Access. 2017;18(5):e57-e61.
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