Bilateral brachial plexus block and avoiding its complications : A case report

Literature on bilateral brachial plexus blocks is rare as it’s seldom performed due to its complications. We present a case of a patient with anticipated difficult airway who underwent bilateral upper limb surgery where brachial plexus blocks were used as the sole mode of anaesthesia. Blocks were performed with plain 0.5% bupivacaine below its maximum safe dose under ultrasound guidance. A good postoperative 24-hour patient satisfaction was noted with no opioid consumption. Potential complications of diaphragmatic paralysis, local anaesthesia systemic toxicity and pneumothorax were mitigated with ultrasound guidance, correct patient selection, while using the knowledge on different types of brachial plexus blocks and local anaesthetic pharmacokinetics.