Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.02.055
Brazilian Journal of Anesthesiology
Case Report

Debridement of axillary necrotizing fasciitis under anesthetic blocks of the serratus plane and supraclavicular brachial plexus: a case report

Debridamento de fascite necrosante axilar sob bloqueios anestésicos do plano serrátil e plexo braquial supraclavicular: relato de caso

Leonardo Saraiva Guimarães de Oliveira, Renata de Andrade Chaves

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Abstract

The regional techniques for axillary analgesia are well established. However, few studies have investigated surgical anesthesia. In this report, extensive debridement of axillary necrotizing fasciitis, including the posteromedial region of the right arm, performed under exclusive regional anesthesia in a patient with probable difficult airway is described. The procedure was performed under a Serratus Plane Block (SPB) and supraclavicular brachial plexus block, guided by ultrasound, and performed with venous sedation. We observed satisfactory anesthesia 15-minutes after the intervention and efficient intraoperative pain control within the following 24 hours. Surgical axilla anesthesia is feasible with the described blocks.

Keywords

Axilla,  Brachial plexus blocks,  Case reports,  Intermediate back muscles,  Regional anesthesia,  Thoracic wall

Resumo

As técnicas regionais de analgesia axilar estão bem estabelecidas. No entanto, poucos estudos investigaram a anestesia cirúrgica. Neste relato é descrito extenso debridamento de fascite necrosante axilar, incluindo a região póstero-medial do braço direito, realizado sob anestesia regional exclusiva em paciente com provável via aérea difícil. O procedimento foi realizado sob bloqueio do plano serrátil (BPS) e bloqueio do plexo braquial supraclavicular, guiado por ultrassom e realizado com sedação venosa. Observamos anestesia satisfatória 15 minutos após a intervenção e controle eficiente da dor intraoperatória nas 24 horas seguintes. A anestesia cirúrgica da axila é viável com os bloqueios descritos.

Palavras-chave

Axila; Bloqueios do plexo braquial; Relatos de casos; Músculos intermediários do dorso; Anestesia regional; Parede torácica

References

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2 R. Blanco, T. Parras, J.G. McDonnell, A. Prats-Galino Serratus plane block: A novel ultrasound-guided thoracic wall nerve block Anaesthesia., 68 (2013), pp. 1107-1113

[3] A. De Cassai, D. Bonvicini, M. Ruol, C. Correale, M. Furnari Erector spinae plane block combined with a novel technique for selective brachial plexus block in breast cancer surgery Korean J Anesthesiol., 72 (2019), pp. 270-274

4 R. Khetarpal, V. Chatrath, A. Dhawan, J. Attri Regional anesthesia in difficult airway: The quest for a solution continues Anesth Essays Res., 10 (2016), pp. 178-183

5 R. Sanllorente-Sebastián, E. Rodríguez-Joris, R. Avello-Taboada, L. Fernández-López, V. Ayerza-Casas, D. Robador-Martínez Addition of serratus-intercostal plane block/BRILMA for arteriovenous access surgery Rev Esp Anestesiol Reanim., 67 (2020), pp. 343-346

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Braz J Anesthesiol

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