BRONCHOSPASM FOLLOWING SUPRACLAVICULAR BLOCK ….A DIAGNOSTIC DILEMMA
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Keywords
Acute respiratory distress, supraclavicular block, ultrasound, sympathetic blockade, local anaesthetic toxicity.
Abstract
INTRODUCTION:
Regional anesthesia techniques, such as brachial plexus blocks, are commonly used for upper limb surgeries due to their efficacy in providing targeted anesthesia and postoperative analgesia. They may be preferred over general anesthesia in patients with compromised cardio-respiratory function or the elderly. We report a case in which the patient developed bronchospasm and acute respiratory failure following a supraclavicular block. Limited reports (two-three) about such incidents have been published.
CASE PRESENTATION: A 70-year-old obese female with chronic hypertension and diabetes, housewife (with chronic use of biofuel), presented with a right forearm fracture and received a right supraclavicular block. Within 20 minutes, she developed acute dyspnea, anxiety, and oxygen saturation of 75%, with bilateral wheezing but no rash or cardiopulmonary compromise. Oxygen and medications were administered to manage the wheezing, and the procedure was postponed. The patient was transferred to the ICU and managed conservatively and later operated on under general anesthesia.
CONCLUSION: The exact cause of bronchospasm was unclear, with possible contributing factors including local anesthetic reaction, cold injection, sympathetic blockade, and her pre-existing respiratory and systemic conditions, the probabilities are multiple but a clear cut answer is none.
References
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Dr. Appari Sri Durga Siva Prasad
MBBS, Post-graduate student, Department of Anaesthesiology, Hamdard Institute of Medical Sciences And Research, New Delhi-110062, India
Dr. Abraq Asma Riyaz
MBBS, MD Anaesthesiology, Associate Professor, Department of Anaesthesiology, Hamdard Institute of Medical Sciences And Research, New Delhi-110062, India
Dr. Mansha Madan
MBBS, MD Anaesthesiology, DNB Anaesthesia, Fellowship in Pain and Palliative Medicine, Assistant professor, Department of Anaesthesiology, Hamdard Institute of Medical Sciences And Research, New Delhi-110062
Dr. Yawar Shoaib Ali
MBBS, MS, MCH Neurosurgery, Associate Director, Department of Neurosurgery, Sarvodya Hospital Faridabad, Haryana-121006, India