Key result
Transversalis fascial plane block combined with brachial plexus block provided safe and effective surgical anesthesia without hemodynamic compromise in an 87-year-old patient with severe aortic stenosis.
Why the study?
General and spinal anesthesia carry significant perioperative risks in patients with severe aortic stenosis, making alternative regional anesthesia techniques necessary for surgical procedures.
Does multi-regional anesthesia (TFPB and BPB) provide safe surgical anesthesia in a patient with severe aortic stenosis undergoing ulnar fracture repair and iliac crest bone graft harvesting?
Case Report (n=1)
No
Does multi-regional anesthesia (TFPB and BPB) provide safe surgical anesthesia in a patient with severe aortic stenosis undergoing ulnar fracture repair and iliac crest bone graft harvesting?
Transversalis fascial plane block combined with brachial plexus block can be a safe and effective alternative to general or spinal anesthesia in patients with severe aortic stenosis undergoing orthopedic surgery involving iliac crest bone grafting.
Supports regional anesthesia feasibility in severe AS; hypothesis-generating and requires prospective validation before practice change.
Regional anesthesia has become an alternative to general anesthesia in patients with risk factors that may cause perioperative complications. The transversalis fascial plane block (TFPB) is a useful regional technique for blocking the ilioinguinal and iliohypogastric nerves. An 87-yearold female patient with symptomatic severe aortic stenosis was scheduled to undergo open reduction and fixation with an autogenous iliac crest bone graft (ICBG) for the nonunion of the proximal shaft of an ulnar fracture. General anesthesia was avoided due to cardiac comorbidities; therefore, regional anesthesia was considered. ICBG can be performed under spinal anesthesia. However, we performed TFPB since severe aortic stenosis is a contraindication for spinal anesthesia. A brachial plexus block was performed for the primary forearm surgical site. The surgery proceeded safely without any hemodynamic compromise or special events. TFPB for ICBG can be a useful alternative in patients with severe cardiac comorbidities to avoid perioperative risks.
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Pak et al. (2023) conducted a case report in Ulnar fracture, iliac crest bone graft harvesting, severe aortic stenosis (n=1). Transversalis fascial plane block (TFPB) combined with brachial plexus block (BPB) was evaluated on Successful surgical anesthesia and hemodynamic stability. Transversalis fascial plane block combined with brachial plexus block provided safe and effective surgical anesthesia without hemodynamic compromise in an 87-year-old patient with severe aortic stenosis.
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