# Peripheral Regional Anesthesia for Awake Emergency Upper Limb Trauma Surgery in an Adult Patient With Fontan Physiology

## TL;DR

This case report shows how regional anesthesia can safely manage surgery for an adult with Fontan heart physiology, avoiding general anesthesia risks.

## Contribution

Demonstrates the successful use of regional anesthesia in an awake adult Fontan patient for emergency upper limb surgery.

## Key findings

- Supraclavicular brachial plexus and intercostobrachial nerve blockade was effective for awake surgery in a Fontan patient.
- Regional anesthesia provided safe and successful pain control without systemic risks in this complex cardiac case.
- The case highlights regional anesthesia as a viable alternative to general anesthesia for noncardiac surgery in Fontan physiology patients.

## Abstract

Background: The Fontan procedure is the principal technique used in the surgical palliation of a range of congenital heart defects involving a single functional ventricle. With improvements in surgical technique and medical management, patients with Fontan physiology are surviving longer and a growing number are now presenting for noncardiac surgery in adulthood. The Fontan physiology provides a unique challenge for anaesthesiologists managing their perioperative care. This case report explores this challenge further and emphasises the benefits which regional anaesthesia can provide in the management of these complex patients.

Case Presentation: We report the successful use of supraclavicular brachial plexus and intercostobrachial nerve blockade for awake surgery in a 27-year-old patient who had previously undergone a Fontan procedure at 5 years of age and now presented for emergency fixation of complex fractures of his radius, ulna and olecranon following a fall from his electric bicycle.

Conclusions: This case report and ensuing discussion highlight the benefits which regional anaesthesia can provide for adult patients with complex cardiac physiology, including Fontan circulation, undergoing noncardiac surgery when compared to general anaesthesia.