[Emergency axillary brachial plexus block in a patient allergic to atropine]

Peripheral nerve blocks can provide a valid alternative for anesthetizing patients with allergy to drugs such as atropine that are often used for general anesthesia. We report the case of a 7-year-old boy (physical status ASA II, weight 28 Kg). Relevant medical history included generalized skin rash and breathing difficulties due to bronchospasm after administration of atropine eyedrops. The boy had never undergone skin testing for allergy. With a diagnosis of distal metaphyseal fracture of the right radius, he was proposed for urgent closed reduction and osteosynthesis of the lesion. After premedication with midazolam, an axillary brachial plexus block with 0.4 mL x Kg(-1) of 1% mepivacaine was performed with the aid of a nerve stimulator. The intervention was uneventful and the patient was free of pain during and after the procedure. Axillary brachial plexus block anesthesia in this pediatric patient was easy to perform, safe, and effective. It provided satisfactory conditions for surgery and made it possible to avoid administering drugs with vagotonic effects that are often used for general anesthesia and require the use of atropine.