Preferred Anesthesia technique in connection with dog bites to a hand

What type of anesthesia technique is suitable for surgical treatment to a hand which incurred a dog bite?

Most dog bite surgeries require anesthesia to the entire arm, this has proven to be the best approach in most cases.

Plexus block

Plexus block is achieved by injecting the anesthetic agent close to the nerve network in the area of the armpit.

A plexus block usually provides numbness to the entire arm within half an hour.

Is it always possible to select this anesthesia technique?

No. This type of anesthesia is not suitable for small children.

Even adults may not always qualify for a plexus block in connection with a dog bite. If the infection is far progressed and there is visible swelling and reddening to the lymphatic system of the upper arm, a plexus block anesthesia can no longer be applied!

Particularly if there is swelling of the lymph nodes in the armpit, injecting an anesthetic agent into the armpit is taboo.

What kind of anesthesia can be selected for such cases then?

In these cases general anesthesia is mandatory! Some patients may find this cumbersome, maybe even risky.

Clearly general anesthesia bears its own risks, nonetheless the situation calls for a benefit-risk-assessment and that should take into account that bacteria from the progressing infection in the hand may already have travelled into the lymphatic system of the armpit.

Under unfavorable circumstances the injection of an anesthetic agent into the armpit (plexus block) may lead to further bacterial contamination.

Ultimately only an individual examination will determine which anesthetic technique will be the better choice for the concerned patient. While evaluating the options a variety of aspects will need to be considered, e.g. how high is the risk factor of a general anesthesia with view to the heart or lung of the patient; how long since the patient had food, etc.

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