An unusual procedure in performing brachial plexus block

A new surgical treatment of pseudarthrosis humeri needed specific anesthesiological management. The relevant problems for the anesthesiologist were the following: one year prior to the present admission the patient suffered from a polytrauma with contusio cerebri and had, as a result of prolonged intubation during the following period of intensive therapy, an excessive tracheal stenosis in the subglottic area, however without any clinical signs. For these reasons, general anesthesia did not seem to be practicable and the conventional way of blocking the brachial plexus appeared to be somewhat problematic owing to the postoperative scar tissue in the previously surgically treated region. For these reasons an unusual anesthetic management was chosen: the brachial plexus was anesthetized in the subaxillar region by surgical exposure of the neurovascular bundle. We feel, that the surgical exposure of the brachial plexus as described here is a practicable alternative to the common techniques of blocking the brachial plexus in very special situations.