Concurrent open reduction and fixation of the femur and humerus under spinal and ultrasound-guided interscalene catheter anaesthesia in a cachectic patient on haemodialysis

Abstract

Purpose: We describe a complex medical case in which an ultrasound-guided interscalene brachial plexus block (ISBPB) was used with continuous perineural infusion and concomitant spinal anaesthesia for surgical anaesthesia and postoperative analgesia in a patient with multiple comorbidities, who required repair of multiple long bone fractures. Materials and methods: The current case report is presented with patient consent and with Institutional Research Ethics Board approval. Results: A 53-year-old female patient with multiple medical comorbidities suffered a fall as a result of a hypoglycemic epi­sode and presented for open reduction and internal fixation of distal femur fracture and revision of the fractured contra-lateral proximal humerus. This case was one of complex surgical anaes thesia and analgesia as a result of the patient’s significant comorbidities including type I diabetes, end-stage renal disease, peripheral vascular disease, hypertension, severe kyphosis, anaemia, hypothyroidism, gastroesophageal reflux disease, chronic cough, chronic steroid use and multiple phar ma cological sensitivities. The use of an ISBPB using an in-dwelling perineural catheter and concomitant spinal anaesthesia provided appropriate surgical anaesthesia and post-operative analgesia. Conclusion: Our case illustrates the success of an ISBPB with continuous perineural infusion with concurrent spinal anaesthesia for surgical anaesthesia and postoperative analgesia in a patient with significant medical comorbidities presenting with two long bone fractures.