Anesthesia & Clinical Research
Open Access

Abstract

Selective Median, Ulnar and Superficial Branch of the Radial Nerve Blockade with Liposomal Bupivacaine for Postoperative Analgesia in a Super-Super Morbidly Obese Patient

Ryan Rihani, Johanna B DeHaan and Nadia Hernandez

Regional anesthesia has become a mainstay for post-surgical pain control, especially in upper extremity surgery. Peripheral nerve blocks have improved quality of recovery by improving pain control, decreasing or eliminating narcotics with associated side effects, and shortening hospital length of stay. Some situations hinder the anesthesiologist’s ability to approach the nerve for blockade using standard techniques, such as poly-trauma hindering positioning due to pain and access due to braces or dressings, infections or wounds at the site of needle entry. Other conditions contribute to the avoidance of brachial plexus blocks such as body habitus and significant pulmonary or cardiovascular disease due to the high likelihood of phrenic nerve paralysis in most brachial plexus blocks. While alternatives to brachial plexus block exist, their use is limited due to the short duration of action of field blocks. In this case report, we discuss the utility of selective median, ulnar and superficial branch of radial nerve blockade with liposomal bupivacaine for extended post-operative analgesia in a super-super morbidly obese patient with multiple comorbidities. This patient’s case supports the utility of isolated nerve blocks in patients with severe upper extremity pain with contraindications to brachial plexus blocks.