Abstract

Anesthetic management of pregnant patients with traumatic brain injury (TBI) requiring
non-obstetric surgery represents a clinical challenge due to the need to simultaneously
maintain maternal hemodynamic stability, cerebral perfusion pressure, and adequate
uteroplacental perfusion. Furthermore, factors that can precipitate secondary brain
injury, such as hypotension, hypoxemia, or hypercapnia, must be avoided. The case of a
29-week pregnant patient with TBI mild injury and right radius and ulna fracture, who
underwent osteosynthesis under ultrasound-guided brachial plexus costoclavicular block
with intravenous sedation. The anesthetic procedure allowed avoiding airway manipulation
and hemodynamic variations associated with general anesthesia. Hemodynamic parameters
remained stable during the intraoperative period, with mean arterial pressure variation
less than ±10% of the baseline value. Fetal heart rate remained within normal ranges
throughout the procedure. Postoperative analgesia was adequate, with a visual analog
scale (VAS) score of 1/10 during the first 24 hours. This case suggests that ultrasound-
guided costoclavicular block may represent a safe and physiologically favorable anesthetic
alternative in selected pregnant patients with mild traumatic brain injury undergoing upper
extremity surgery. The technique allows maintaining hemodynamic stability, preserving
cerebral perfusion, uteroplacental perfusion, and avoids airway manipulation. Additional
studies are required to evaluate its potential impact on maternal-fetal neuroprotection.
The available literature on regional anesthesia in pregnant patients with traumatic brain
injury is limited and mainly restricted to isolated reports of interscalene or supraclavicular
blocks. However, these approaches may be associated with respiratory complications or a
higher risk of pneumothorax. The brachial plexus costoclavicular block, recently described
with the development of ultrasound-guided regional anesthesia, offers anatomical and
physiological advantages that could make it particularly useful in this clinical scenario.
To our knowledge, there are few reports documenting its use in pregnant patients with
traumatic brain injury undergoing upper extremity surgery. The present case illustrates the
feasibility and potential hemodynamic benefits of this technique, highlighting its possible
role as a neuroprotective anesthetic strategy in complex clinical situations

Keywords

costoclavicular block, pregnancy, mild traumatic brain injury, regional anesthesia, non-obstetric surgery