Concomitant costoclavicular and axillary block. Case report

Purpose

Upper limb surgeries can be performed with axillary brachial plexus block (ABPB). In some situations, it is not possible to obtain the adequate position for the blockade, so the costoclavicular approach can be used. In this case report, an 83-year-old patient had a movement restriction that made axillary anesthesia impossible. After the costoclavicular block, there was relaxation of the upper limb muscles, making it possible to perform the axillary block.

Clinical features

An 83-year-old patient with osteomyelitis of the distal end of the proximal phalanx and proximal interphalangeal joint of the 5th right finger was admitted for collection of soft tissue material and bone fragments for culture. He had a vicious semi-flexed position of the right upper limb, making it impossible to perform ABPB, due to the impossibility of accessing the needle insertion surface. Thus, the brachial plexus block was performed through the costoclavicular block (CCB) with less than half of the dose foreseen for the procedure. With the relaxation provided by the blockade, it was then possible to perform the brachial plexus blockade through the axillary route with the remainder of the dose. The procedure was performed uneventfully with good recovery of the patient.

Conclusion

Performing a concomitant brachial plexus block may make it possible to perform procedures at the distal end of the upper limb in patients with a semi-flexed vicious position.