Bilateral ultrasound-guided axillary brachial plexus block for hand reconstruction in severe post-burn cervicofacial contracture: A Case Report

Abstract

Background. Severe post-burn cervicofacial contractures can complicate airway management during reconstructive surgery.

Objective. To describe bilateral axillary brachial plexus blockade, serial physiological measurements, and recovery during bilateral hand contracture release.

Methods. A 47-year-old woman weighing 56 kg with cervicofacial flap scarring underwent bilateral ultrasound-guided axillary blocks without sedation. The reported dose was 20 mL of 2% lidocaine (400 mg) per side, with a reported 30-minute interval. Hemodynamics, sensorimotor onset, adverse events, and recovery were assessed at twelve perioperative time points.

Results. Sensory and motor blockade were reported at 12 and 15 minutes per limb, respectively. Surgery lasted 95 minutes without airway instrumentation. Recorded mean arterial pressure ranged from 85.33 to 96.00 mmHg (−7.25% to +4.35% from baseline), rate-pressure product from 8,584 to 10,752 bpm·mmHg, and room-air oxygen saturation from 99% to 100%. No clinical signs of local anesthetic systemic toxicity were reported. The reported Naranjo score was 0. No systemic opioids were required, discharge occurred on postoperative day two, and six-week follow-up found no persistent neurological deficits.

Conclusion. Bilateral axillary blockade permitted hand reconstruction without airway instrumentation in this patient. The single-case design cannot establish comparative superiority or general pharmacokinetic safety; the reported cumulative lidocaine dose requires author clarification.