Brachial plexus block in a parturient.

Area of Science:

• Anesthesiology
• Obstetrics
• Regional Anesthesia

Background:

• Brachial plexus blocks are commonly used for upper extremity procedures.
• Anesthesia in pregnant patients (parturients) requires careful consideration due to physiological changes.
• Phrenic nerve paresis is a potential complication of brachial plexus blocks, particularly concerning in parturients.

Observation:

• A 25-year-old parturient at 34 weeks gestation presented with a humerus fracture due to an intramedullary mass.
• A two-site ultrasound-guided brachial plexus block was performed using ropivacaine.
• The procedure aimed to optimize anesthesia coverage while minimizing phrenic nerve involvement.

Findings:

• Successful tumor biopsy was achieved using only local anesthetics, without sedatives or analgesics.
• The patient exhibited normal respiration and oxygenation post-procedure, with no reported breathing difficulties.
• This case represents the second reported brachial plexus block in a parturient and the first using ultrasound guidance without respiratory compromise.

Implications:

• Ultrasound-guided brachial plexus blocks can be a safe and effective anesthetic option for parturients undergoing upper extremity surgery.
• This technique may reduce the risk of respiratory complications compared to traditional methods in pregnant patients.
• Further investigation into diaphragmatic function post-block in parturients is warranted, though clinical observation suggests potential tolerance.