P102 Supraclavicular brachial plexus block and procedural sedation for muscle biopsy in an 11 year old boy with duchene muscular dystrophy – a case report

<h3>Background and Aims</h3> Duchene muscular dystrophy (DMD) is the most common hereditary neuromuscular disease. Afflicted patients present an anesthetic challenge because there is risk of rhabdomyolysis leading to hyperkalemia, as well as airway management problems, and exacerbation of respiratory failure. As such regional anesthesia (RA) may present a safe and effective solution, especially in the form of a brachial plexus block (BPB) for surgeries of the arm. <h3>Methods</h3> An 11 year old boy suffering from Duchene muscular dystrophy, weighing 25 kg, was scheduled for elective biopsy of the biceps brachii muscle. On induction the patient received Midazolam, Fentanyl, and Propofol. Sedation was maintained via continuous Propofol, with the patient breathing spontaneously. Having in mind the position of the incision we opted for an ultrasound guided supraclavicular BPB with 20 ml of 0.25% Levobupivacaine. <h3>Results</h3> Throughout the 60 min procedure the patient maintained perfect hemodynamic and respiratory stability. Awakening was uneventful, and non-steroidal anti-inflammatory drugs (NSAID) were instituted at 6 h postoperatively. No opioids were given postoperatively. <h3>Conclusions</h3> Diagnosis of DMD and assessment of therapeutic effect often require muscle biopsy, most commonly the biceps brachii, which may not be completely covered by an axillary BPB, but is most certainly covered by a supraclavicular BPB. Performing such cases under regional anesthesia eliminates all the risks of general anesthesia associated with DMD. The block provides superior postoperative analgesia of the upper arm, reducing the postoperative dosage of NSAID and eliminating the need for opioids. Special care must be taken to assess the risk of regurgitation and aspiration, and to institute timely prophylactic measures.