संज्ञानश्वासन और निदान शोध जर्नल
खुला एक्सेस

अमूर्त

Combined Unilateral Supraclavicular and Infraclavicular Brachial Plexus Blocks Anesthesia for above Elbow Amputation in Tetanus Weapon Wounded Patient in a Low Resource Context: A Case Report

Ahmed Salman1*, Aktham Elfarnawany1, Alaje Tekie Bahta1, Akshaya Kumar Baral1, Kenneth Naetio Ozoilo1, Sophie Crespo2

Background: Since preventable by vaccination, tetanus is a rare condition, yet two-third of the worldwide cases of this potentially fatal condition occur in Africa. Most tetanus cases need a surgical procedure (wound debridement mostly), and anesthesia is challenging because of the disease’s potential to cause autonomic dysfunction and muscle stiffness. So far, no consensus for the better anesthesia technique has been described in the literature, and to our knowledge no data about sole ultrasound-guided locoregional anesthesia for limb surgical procedure of the tetanus patient has been published.

Case presentation: A 22-year-old male tetanus patient presented with an infected gunshot wound on the right forearm with a right radio-ulnar fracture and gangrene of the distal half of the right forearm planned for immediate amputation. The anesthesia was achieved by combining unilateral ultrasound-guided supraclavicular and infraclavicular brachial plexus block. The loco-regional anesthesia was effective throughout the duration of surgery without further need for additional anesthetic techniques.

Conclusion: It is an original case report, which raises awareness to consider loco-regional anesthesia as a possible safe alternative to general anesthesia in a tetanus case, which is interesting in low resources settings, where general anesthesia and intubation can be correlated with higher risks. Furthermore, it discusses the option of performing a combined blocks approach in case of concerns about partial failure with a single plexus block. We believe this report could be helpful for anesthesiologists confronted to the difficult and rare situation of taking care of a tetanus patient.