Ultrasound guided Axillary Brachial plexus block in a patient with incidental thrombocytopenia: a case report and review of literature

Background: Incidental isolated thrombocytopenia is an infrequent finding among pre-surgical patients. The benefits of investigating the mechanism of thrombocytopenia in pre-anaesthetic check-up and clinical management of such a patient is unknown. Further, there are lack of clear guidelines on peripheral nerve blockade in a patient of coagulopathy which creates dilemma among anaesthesiologists in emergency situation where prior optimisation is not possible.
Case presentation: We report a case of machine cut injury of the wrist posted for exploration and repair who was incidentally discovered to have isolated thrombocytopenia. The patient had no history of bleeding tendencies or fever. He was a chronic smoker and tobacco chewer with bilateral wheeze on chest auscultation and decreased mouth opening. General Anaesthesia had considerable risks in view of difficult airway, chances of intraoperative bronchospasm and post-operative pulmonary complications. We opted for ultrasound guided axillary brachial plexus block after considering the risk-benefit ratio and informing the surgeons and patient. Postoperatively, we monitored the patient for 24 hours and ruled out any haematological and neurological complications. Conclusions: There is paucity of literature on the implications of isolated thrombocytopenia and the safety of peripheral nerve blocks in such patients. This article stresses the need for further large-scale studies to define the lower limit of platelet count and higher limit of INR beyond which peripheral nerve blockade should not be performed.