Ultrasound-guided bilateral brachial plexus blockade with propofol-ketamine sedation

We report the use of ultrasound-guided bilateral brachial plexus block in a patient with bilateral radius fractures. An axillary block was performed on the patient’s right and a supraclavicular block on her left using an in-plane (long-axis) needle insertion technique. Into each side was injected 20 ml 0.5% ropivacaine, giving a total volume (dose) of 40 ml (200 mg). Provisions were made for rescue analgesia or unplanned conversion to general anesthesia during the operation, but these were not needed; furthermore, no perioperative complications were observed. General anesthesia has traditionally been used for simultaneous surgery involving the bilateral upper extremities because of concerns relating to local anesthetic toxicity, phrenic nerve blockade, and pneumothorax. The ultrasound-guided technique facilitates a reduction in the minimal effective volume of local anesthetic and can prevent potentially critical complications. Moreover, the technique can be performed within the recommended safe dose limits of the anesthetic, rendering it an important option for bilateral upper extremity surgery.