Brachial plexus block in a parturient

We report a novel circumstance of brachial plexus anesthesia in a parturient. A 25-year-old woman at 34 weeks of gestation presented with a pathologic proximal right humerus fracture from an intramedullary mass. She was scheduled for tumor biopsy which was performed using a two-site ultrasound-guided brachial plexus block to maximize odds of complete anesthesia while minimizing the risk of phrenic nerve paresis. After a supraclavicular block with 0.5% ropivacaine 20 mL, we translated our ultrasound probe cephalad, inferior to the root of C7 where the divisions of the superior trunk could be seen in a tightly compact arrangement. An additional injection of 0.5% ropivacaine 20 mL was administered at this site, and the patient subsequently underwent successful biopsy without sedatives or analgesics, aside from local anesthetics. In the post-anesthesia care unit, she had normal respirations and oxygen saturations breathing room air, denied any shortness of breath or difficulty breathing, and was discharged shortly after her arrival. While we did not pursue radiologic examination to rule out hemidiaphragm paralysis, we assumed, as evidenced in a previous case report, that unlike most healthy patients, a parturient would demonstrate some clinical signs and/or symptoms of hemidiaphragm paralysis, given that the diaphragm is almost totally responsible for inspiration in the term parturient. This represents only the second brachial plexus block in a parturient reported in the literature; the first using ultrasound guidance and without respiratory embarrassment.