• Deeptiman James and Meghna Jiwanmall.
• Department of Orthopaedics, Paediatric Orthopaedic Unit, Christian Medical College, Vellore 632004, Tamil Nadu, India.
• Natl Med J India. 2020 Mar 1; 33 (2): 69-73.

Background. Surgical healthcare across low- and middle-income countries is plagued with concerns over scarcity of anaesthesiologists. Orthopaedic surgeons working in such resource-limited settings are often caught in a dilemma to provide emergency orthopaedic surgical care without an attending anaesthesiologist. Therefore, an effective, low-risk solution is necessary to ensure safe emergency orthopaedic care.Methods. We evaluated the incidence of 'anaesthesia-related complications' and 'intraoperative adjuvant medications' for maintenance of adequate anaesthesia for patients who underwent emergency upper limb procedures at a remote mission hospital in rural central India, from June 2013 to June 2016. Emergency cases where there was no anaesthesio-logist were analyzed. Data were collected from the Hospaa 3 HMS software, orthopaedic surgical logbook and inpatient records from 2013 to 2016.Results. Sixty-eight patients underwent an 'axillary block' for emergency orthopaedic procedures. Twelve (17.6%) patients had partial block and needed adjuvant medications, 1 (1.4%) patient developed ulnar nerve palsy with partial recovery. Seventy-six adjuvant medications were administered at a mean of 1.19 per patient during the intraoperative period.Conclusions. Axillary regional block is an efficacious, low-risk anaesthesia for emergency orthopaedic procedures of the hand, forearm and elbow, in resource-limited settings where an anaesthesiologist is not available.

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