Importance of sympathectomy induced by continuous brachial plexus block for digital replantation in a patient with liver cirrhosis: Case report
Keywords:
Liver cirrhosis, Nerve block, Microsurgery, Brachial Plexus, Anesthesia
Abstract
Hand microsurgeries are procedures performed by reconstructive surgeons and require a complex and highly individualized approach. The management of anesthesia in patients with cirrhosis may be challenging. Liver dysfunction may condition the extended use of anesthetic agents as a result of a disrupted metabolism and clearance.
This case describes the anesthetic management of a patient with cirrhosis, using a combined anesthetic technique with continuous axillary block of the brachial plexus to prevent postoperative pain and maintain extended vasodilatation. The continuous brachial plexus block under local anesthesia has shown improved tissue perfusion following limb replantation surgery. This technique is particularly helpful to prevent vasospasm in the reconstructed tissue during the postoperative period. In patients with cirrhosis, this technique provides adequate postoperative pain control.
References
1. Su HH, Lui PW, Yu CL, Liew CS, Lin CH, Lin YT, et al. The effects of continuous axillary brachial plexus block with ropivacaine infusion on skin temperature and survival of crushed fingers after microsurgical replantation. Chang Gung Med J. 2005;28:567-74.
2. Kurt E, Ozturk S, Isik S, Zor F. Continuous brachial plexus blockade for digital replantations and toe-to-hand transfers. Ann Plast Surg. 2005;54:24-7.
3. Taras JS, Behrman MJ. Continuous peripheral nerve block in replantation and revascularization. J Reconstr Microsurg. 1998;14:17-21.
4. Sabaté A, Acosta Villegas F, Dalmau A, Koo M, Sansano Sánchez T, García Palenciano C. Anesthesia in the patient with impaired liver function. Rev Esp Anestesiol Reanim. 2011;58:574-81.
5. Ziser A, Plevak DJ. Morbidity and mortality in cirrhotic patients undergoing anesthesia and surgery. Curr Opin Anaesthesiol. 2001;14:707-11.
6. Berger A, Tizian C, Zenz M. Continuous plexus blockade for improved circulation in microvascular surgery. Ann Plast Surg. 1985;14:16-9.
7. Ilfeld BM. Continuous peripheral nerve blocks: a review of the published evidence. Anesth Analg. 2011;113:904-25.
8. Li J, Karmakar MK, Li X, Kwok WH, Kee WD. Regional hemodynamic changes after an axillary brachial plexus block: a pulsed-wave Doppler ultrasound study. Reg Anesth Pain Med. 2012;37:111-8.
9. Bergman BD, Hebl JR, Kent J, Horlocker TT. Neurologic complications of 405 consecutive continuous axillary catheters. Anesth Analg. 2003;96:247-52.
10. Ekatodramis G, Macaire P, Borgeat A. Prolonged Horner syndrome due to neck hematoma after continuous interscalene block. Anesthesiology. 2001;95:801-3.
11. Vásques MI, Jiménez AM, Aguirre OD, González MP, Ríos AM. Bloqueo supraclavicular bilateral con ecografía. Rev Colomb Anestesiol. 2012;40:304-8.
12. Ortega Romero A, de Diego Isasa D, del Olmo Rodríguez C, Maroto Ramos E, Rouco Gil R. Ecografía portátil en anestesia regional: bloqueos del plexo braquial. Rev Esp Anestesiol Reanim. 2008;55:294-303.
13. Greengrass RA, Feinglass NG, Murray PM, Trigg SD. Continuous regional anesthesia before surgical peripheral sympathectomy in a patient with severe digital necrosis associated with Raynaud's phenomenon and scleroderma. Reg Anesth Pain Med. 2003;28:354-8.
14. Kiamanesh D, Rumley J, Moitra VK. Monitoring and managing hepatic disease in anaesthesia. Br J Anaesth. 2013;111:50-61.
15. Paulino Leal-Villalpando R, Garduño AD. Evaluación y manejo perioperatorio del paciente con cirrosis hepática para cirugía no hepática. Rev Mex Anestesiol. 2008;31:132-8.
16. Hoetzel A, Ryan H, Schmidt R. Anesthetic considerations for the patient with liver disease. Curr Opin Anaesthesiol. 2012;25:340-7.
17. Sorensen J, Bengtsson M, Malmqvist EL, Nilsson G, Sjoberg F. Laser Doppler perfusion imager (LDPI) - for the assessment of skin blood flow changes following sympathetic blocks. Acta Anaesthesiol Scand. 1996;40:1145-8.
18. Breschan C, Kraschl R, Jost R, Marhofer P, Likar R. Axillary brachial plexus block for treatment of severe forearm ischemia after arterial cannulation in an extremely low birth-weight infant. Pediatr Anesth. 2004;14:681-4.
2. Kurt E, Ozturk S, Isik S, Zor F. Continuous brachial plexus blockade for digital replantations and toe-to-hand transfers. Ann Plast Surg. 2005;54:24-7.
3. Taras JS, Behrman MJ. Continuous peripheral nerve block in replantation and revascularization. J Reconstr Microsurg. 1998;14:17-21.
4. Sabaté A, Acosta Villegas F, Dalmau A, Koo M, Sansano Sánchez T, García Palenciano C. Anesthesia in the patient with impaired liver function. Rev Esp Anestesiol Reanim. 2011;58:574-81.
5. Ziser A, Plevak DJ. Morbidity and mortality in cirrhotic patients undergoing anesthesia and surgery. Curr Opin Anaesthesiol. 2001;14:707-11.
6. Berger A, Tizian C, Zenz M. Continuous plexus blockade for improved circulation in microvascular surgery. Ann Plast Surg. 1985;14:16-9.
7. Ilfeld BM. Continuous peripheral nerve blocks: a review of the published evidence. Anesth Analg. 2011;113:904-25.
8. Li J, Karmakar MK, Li X, Kwok WH, Kee WD. Regional hemodynamic changes after an axillary brachial plexus block: a pulsed-wave Doppler ultrasound study. Reg Anesth Pain Med. 2012;37:111-8.
9. Bergman BD, Hebl JR, Kent J, Horlocker TT. Neurologic complications of 405 consecutive continuous axillary catheters. Anesth Analg. 2003;96:247-52.
10. Ekatodramis G, Macaire P, Borgeat A. Prolonged Horner syndrome due to neck hematoma after continuous interscalene block. Anesthesiology. 2001;95:801-3.
11. Vásques MI, Jiménez AM, Aguirre OD, González MP, Ríos AM. Bloqueo supraclavicular bilateral con ecografía. Rev Colomb Anestesiol. 2012;40:304-8.
12. Ortega Romero A, de Diego Isasa D, del Olmo Rodríguez C, Maroto Ramos E, Rouco Gil R. Ecografía portátil en anestesia regional: bloqueos del plexo braquial. Rev Esp Anestesiol Reanim. 2008;55:294-303.
13. Greengrass RA, Feinglass NG, Murray PM, Trigg SD. Continuous regional anesthesia before surgical peripheral sympathectomy in a patient with severe digital necrosis associated with Raynaud's phenomenon and scleroderma. Reg Anesth Pain Med. 2003;28:354-8.
14. Kiamanesh D, Rumley J, Moitra VK. Monitoring and managing hepatic disease in anaesthesia. Br J Anaesth. 2013;111:50-61.
15. Paulino Leal-Villalpando R, Garduño AD. Evaluación y manejo perioperatorio del paciente con cirrosis hepática para cirugía no hepática. Rev Mex Anestesiol. 2008;31:132-8.
16. Hoetzel A, Ryan H, Schmidt R. Anesthetic considerations for the patient with liver disease. Curr Opin Anaesthesiol. 2012;25:340-7.
17. Sorensen J, Bengtsson M, Malmqvist EL, Nilsson G, Sjoberg F. Laser Doppler perfusion imager (LDPI) - for the assessment of skin blood flow changes following sympathetic blocks. Acta Anaesthesiol Scand. 1996;40:1145-8.
18. Breschan C, Kraschl R, Jost R, Marhofer P, Likar R. Axillary brachial plexus block for treatment of severe forearm ischemia after arterial cannulation in an extremely low birth-weight infant. Pediatr Anesth. 2004;14:681-4.
How to Cite
1.
Guerrero-Domínguez R, López-Herrera-Rodríguez D, Fernández-Castelllano G, Federero F, Jiménez I. Importance of sympathectomy induced by continuous brachial plexus block for digital replantation in a patient with liver cirrhosis: Case report. Colomb. J. Anesthesiol. [Internet]. 2015 Jul. 1 [cited 2024 Apr. 17];43(3):250-3. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/196
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Published
2015-07-01
How to Cite
1.
Guerrero-Domínguez R, López-Herrera-Rodríguez D, Fernández-Castelllano G, Federero F, Jiménez I. Importance of sympathectomy induced by continuous brachial plexus block for digital replantation in a patient with liver cirrhosis: Case report. Colomb. J. Anesthesiol. [Internet]. 2015 Jul. 1 [cited 2024 Apr. 17];43(3):250-3. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/196
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Section
Case Report / Case Series
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