Year : 2012  |  Volume : 6  |  Issue : 4  |  Page : 423-425

Role of ultrasound-guided continuous brachial plexus block in the management of neonatal ischemia in upper limb

1 Department of Pediatric Surgery, Grant Medical College and Sir J.J. Hospital, Mumbai, Maharashtra, India
2 Department of Anesthesia, Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India

Correspondence Address:
Vrushali C Ponde
Amber Croft Annexe 302, Ambedkar Road, Pali Hill, Mumbai - 400 052, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1658-354X.105898

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Neonatal upper limb ischemia due to accidental arterial damage remains a major concern, which can lead to devastating complications if untreated. The primary objective of this case report is to emphasize the role of continuous infraclavicular brachial plexus block, the issues related with block performance in an ischemic hand, and the importance of ultrasound guidance in this particular case scenario. A 1.1 kg infant suffered from distal forearm ischemia due to accidental arterial damage, which was treated with brachial plexus block. An ultrasound-guided single shot block with 0.5 mL/kg of 0.25% bupivacaine was followed by ultrasound-guided catheter placement in the target area. A continuous infusion of 0.03% of bupivacaine at the rate of 0.5 mL/kg/hr (approx. 0.15 mg/kg/h of bupivacaine) was administered for 36 h. This treatment resulted in reversal of ischemia. Permanent ischemic damage was eventually confined to the tips of 4 fingers. We conclude that ultrasound-guided continuous infraclavicular block has a therapeutic role to play in the treatment of hand ischemia due to arterial damage and subsequent arterial spasm in neonates with added benefits.

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