DOI: https://doi.org/10.14710/jai.v0i0.78083

Safe and Effective Perioperative Management in Patients with Atrial Septal Defect and Pulmonary Contusion: A Case Study with Supraclavicular Block

Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Universitas Sebelas Maret/Dr. Moewardi General Hospital, Surakarta, Indonesia

Received: 25 Sep 2025; Revised: 13 Apr 2025; Accepted: 22 Apr 2025; Available online: 23 Apr 2025.
Open Access Copyright 2026 JAI (Jurnal Anestesiologi Indonesia)
Creative Commons License This work is licensed under a Creative Commons Attribution 4.0 International License.

Citation Format:
Cover Image
Abstract

Background: Peripheral nerve blocks offer a safer anesthetic alternative in patients with congenital heart disease (CHD) by reducing cardiovascular and pulmonary risks associated with general anesthesia. The supraclavicular brachial plexus block provides effective anesthesia for upper limb surgery with improved hemodynamic stability, reduced complications, and better postoperative analgesia. This case report aims to demonstrate the safety and effectiveness of supraclavicular brachial plexus block as a perioperative anesthetic strategy in a high-risk patient with CHD and pulmonary contusion.

Case: A 67-year-old woman with a large secundum atrial septal defect (ASD), severe pulmonary hypertension, right ventricular dysfunction, and bilateral lung contusions on day 10 was scheduled for open reduction internal fixation (ORIF) of a distal radius fracture. Due to high cardiopulmonary risk, regional anesthesia was chosen. An ultrasound- and nerve stimulator-guided supraclavicular block using 20 mL of levobupivacaine 0.375% was performed. The procedure was completed successfully with stable hemodynamics and preserved spontaneous ventilation. Postoperatively, the patient was monitored in a high-care unit (HCU).

Discussion: Maintaining hemodynamic stability and avoiding increases in pulmonary vascular resistance (PVR) are critical in acyanotic left-to-right shunt CHD. General anesthesia and mechanical ventilation may disrupt Qp:Qs balance and worsen pulmonary function, especially in pulmonary contusion. Regional anesthesia minimizes these risks while providing adequate surgical conditions.

Conclusion: Supraclavicular brachial plexus block is a safe and effective alternative for upper limb surgery in high-risk CHD patients with acyanotic shunt lesions and pulmonary complications.

Note: This article has supplementary file(s).

Fulltext View|Download |  common.other
Copyright Transfer Agreement
Subject
Type Other
  Download (607KB)    Indexing metadata
Email colleagues
Keywords: adult congenital heart disease; pulmonary contusion; radius fracture; perioperative; supraclavicular block

Article Metrics:

Article Info
Section: Case Reports
Language : EN
Most cited articles
Patofisiologi Penyakit Jantung Koroner Midazolam Intravena Dosis Rendah Tidak Mempengaruhi Nitric Oxide Intraperitoneal Mencit Balb/C Yang Terpapar Lipopolisakarida More cited articles
  1. Spiro J, Bauerle J, Njoku D. Anaesthesia for children with heart disease undergoing non-cardiac surgery. BJA Educ [Internet]. 2024;24(12):322–34. Available from: https://doi.org/10.1016/j.bjae.2024.08.004
  2. Kuntoadi D, Utama SP, Yuliana F, Hermawan A. Peripheral Nerve Block as A Safer Alternative than General Anesthesia in High-Risk Patients with Multiple Comorbidities : A Case Report. Solo J Anesth Pain Crit Care E-ISSN. 2025;5(1)
  3. Rauwelio A, I Made Dwi Pramana, Benny Supono, Ida Ayu Apsari Pradnya Niti, William Audi, I Wayan Widana. Supraclavicular Block Using Ultrasonography (USG) Guidance in Patients with Moderate Radius Ulna Fractures Mitral Regurgitation Undergoing ORIF (Open Reduction and Internal Fixation): A Case Report. Biosci Med J Biomed Transl Res. 2024;8(7):4618–24
  4. ai AW, Pistner AR, Krieger E V. Adult Congenital Heart Disease in the Aging and Elderly Population. Curr Geriatr Reports. 2023;12:157–66
  5. Junghare SW, Desurka V. Congenital heart diseases and anaesthesia. Indian J Anaesth. 2017;61:744–52
  6. Burt CC, Littwin SM, Adebayo J, Mallavaram NA, Thys DM. Regional Anesthesia & Cardiovascular Disease. In: The New York School of Regional Anesthesia HADZIC’S TEXTBOOK OF REGIONAL ANESTHESIA AND ACUTE PAIN MANAGEMENT. 2nd ed. New York: McGraw-Hill Education; 2017. p. 881–5
  7. Choudhary S, Pasrija D, Mendez MD. Pulmonary contusion. Essent Emerg Trauma. 2024;1–10
  8. Fernandez-Bustamante A, Wood CL, Tran Z V., Moine P. Intraoperative ventilation: Incidence and risk factors for receiving large tidal volumes during general anesthesia. BMC Anesthesiol [Internet]. 2011;11(1):22. Available from: http://www.biomedcentral.com/1471-2253/11/22
  9. Gajic, O., Dara, S. I., Mendez, J. L., Adesanya, A. O., Festic, E., Caples, S. M., Rana, R., st. Sauver, J. L., Lymp, J. F., Afessa, B., & Hubmayr, R. D. (2004). Ventilator-associated lung injury in patients without acute lung injury at the onset of mechanical ventilation*. Critical Care Medicine, 32(9), 1817–1824. https://doi.org/10.1097/01.CCM.0000133019.52531.30
  10. Raghove, P., Singh, K., Taxak, S., Ahlawat, M., & Hooda, S. (2016). Comparison of Ultrasound Guided Technique with Conventional Landmark Technique for Supraclavicular Brachial Plexus Nerve Block in Patients Undergoing Upper Limb Surgery. International Journal of Pharmacology and Clinical Sciences, 5(1), 1–4. https://doi.org/10.5530/ijpcs.5.1.1
  11. D’Souza, R. S., & Johnson, R. L. (2023). Supraclavicular Block. Brown’s Atlas of Regional Anesthesia, 63–66. https://doi.org/10.1016/B978-0-443-11221-8.00008-7
  12. Kuntoadi, D., Utama, S. P., Yuliana, F., & Hermawan, A. (2025). Peripheral Nerve Block as A Safer Alternative than General Anesthesia in High-Risk Patients with Multiple Comorbidities: A Case Report. Solo Journal of Anesthesi, Pain and Critical Care (SOJA), 5(1), 115. https://doi.org/10.20961/soja.v5i1.95022
  13. Shalaby, M., & Sahni, R. (2023). Supraclavicular brachial plexus block: the unsung hero of emergency department regional anesthesia. Clinical and Experimental Emergency Medicine, 10(3), 342–344. https://doi.org/10.15441/ceem.23.035
  14. Gamo, K., Kuriyama, K., Higuchi, H., Uesugi, A., Nakase, T., Hamada, M., & Kawai, H. (2014). Ultrasound-guided supraclavicular brachial plexus block in upper limb surgery: outcomes and patient satisfaction. The Bone & Joint Journal, 96-B(6), 795–799. https://doi.org/10.1302/0301-620X.96B6.31893
  15. Hines RL, Marschall KE. IMPORTANT MANAGEMENT STRATEGIES FOR ADULTS WITH CONGENITAL HEART DISEASE. In: STOELTING’S ANESTHESIA AND CO-EXISTING DISEASE. 7th ed. Philadelphia: Elsevier; 2018. p. 145–6

Last update:

No citation recorded.

Last update: 2026-06-08 11:32:42

No citation recorded.