Bilateral brachial plexus block in a patient with cervical spinal cord injury: A case report

RATIONALE: Bilateral brachial plexus block (BPB) generally requires a relatively large dose of local anesthetic for a successful block, resulting in a high risk of local anesthetic systemic toxicity. It can also result in inadvertent bilateral phrenic nerve palsy, leading to respiratory failure. Hence, it has not been widely used. However, it can be performed in selected patients. In this report, we present a case of ultrasound-guided BPB for bilateral upper extremity surgery in a patient with cervical spinal cord injury (SCI). PATIENT CONCERNS: A 25-year-old woman with SCI secondary to traumatic fifth cervical spine fracture scheduled for surgical treatment of bilateral elbow fracture received bilateral BPB. DIAGNOSES: Due to the complications of SCI, the patient had incomplete sensory loss, loss of motor function, and complete diaphragmatic paralysis on the right side. INTERVENTIONS: Right infraclavicular and left axillary BPB was performed as the sole anesthetic procedure for bilateral upper extremity surgery. OUTCOMES: Bilateral BPB was successful for bilateral upper extremity surgery. The surgery was uneventful and without further complications. LESSONS: Patients with cervical SCI have a high risk of respiratory complications. Bilateral BPB can be a suitable option for bilateral upper extremity surgery in selected patients. It is imperative to select an appropriate anesthetic technique that preserves respiratory function to minimize the potential risk of respiratory complications.