Distal nerve blocks at the elbow for traumatic fingertip semi-amputation repair - A case report

Regional anesthesia has been proven useful in hand surgery after trauma, most commonly via brachial plexus blocks (BPB), with widely established benefits. Distal nerve blocks at the elbow are used much less frequently. A 15-year-old boy was admitted because of traumatic amputation of the 4^th digit on his right hand. Difficult intubation was suspected. History was indicative of obstructive sleep apnea, and nil per os status was confirmed, with no apparent risk factors for regurgitation. Ultrasound-guided blocks of the median, radial, and ulnar nerves at the elbow were performed with 2% Lidocaine and 0.5% Levobupivacaine. Sedation was maintained with Propofol 3-4 mg/kg/h, with oxygen support via nasal cannula at 3 L/min. Basic monitoring of vital functions was applied. Throughout the procedure, the patient maintained perfect hemodynamic and respiratory stability. Postoperative analgesia was adequate, with no nonsteroidal anti-inflammatory drugs administered in the first 12 h postoperatively. Distal nerve blocks at the elbow may present a safe and effective anesthetic technique when managing traumatic injuries of the fingers, presenting a simpler and less risky technique than BPB and requiring less provider expertise. Previous studies have demonstrated the use of these blocks in acute pain management following fractures, but to our knowledge, no inquiry has been made into the use of these blocks for surgical anesthesia in amputation management. One needs to keep in mind the dermatomal distribution of innervation as other digits may not require covering all three nerves as the 4^th digit does. Caution must be taken to account for any possibility of increased risk of regurgitation, as well as the use of an upper arm pneumatic tourniquet.