Multi-regional anesthesia for ulnar fracture and iliac crest bone graft harvesting in a patient with severe aortic stenosis: a case report

Multi-regional anesthesia for ulnar fracture and iliac crest bone graft harvesting in a patient with severe aortic stenosis: a case report

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-year old 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.