A Case of Upper Limb Amputation Managed with USG-guided Continuous Infraclavicular Nerve Block for Improved Postoperative Analgesia
Dr. Atluri Harika,
Resident, Department of Anaesthesiology, D.Y. Patil Medical College, Hospital and Research Centre, Carnation Girls Hostel, Pimpri, Pune-411018, Maharashtra, India.
Phantom Limb Pain (PLP) is defined as any perceived painful sensation localised to the region of the amputated body part, while phantom limb sensations are non painful sensations emanating from the phantom limb, including proprioceptive awareness, kinetic, exteroceptive, and superadded sensations. The mode of anaesthesia administered during amputation is an important factor in determining the emergence of PLP or phantom sensations. The majority of patients requiring emergency care are victims of traumatic injuries to the upper limbs, which are most often treated conservatively. The authors present the case of a 67-year-old male patient who sustained a fall on his arm while carrying a metal container, resulting in a laceration to his left arm that led to disruption of brachial artery blood flow, necessitating amputation. Although upper limb injuries are relatively common, concurrent vascular injuries are rare. However, when a major vessel such as the brachial artery is injured, amputation may be required. This loss of a limb can result in PLP. To prevent this, the authors used a unique and rare protocol of Continuous Peripheral Nerve Block (CPNB) in the present case. It not only underscored the importance of intraoperative analgesia in preventing PLP but also proved to be a crucial anaesthetic tool in facilitating the surgery and providing the patient with a more comfortable postoperative recovery.