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The Use of Cervical Paravertebral Block as the Sole Anesthetic for Shoulder Surgery in a Morbid Patient: A Case Report
  1. Robert Koorn, M.D.,
  2. Kathleen M Tenhundfeld Fear, C.R.N.A., M.S.N.,
  3. Chantelle Miller, M.D. and
  4. André Boezaart, M.D., Ph.D.
  1. From the Department of Anesthesia and College of Nursing, University of Iowa, Iowa City, IA
  1. Reprint requests: André P. Boezaart, M.D., Ph.D., Department of Anesthesia, 200 Hawkins Drive 6407 JCP, Iowa City, IA 52242-2940 USA. E-mail: andre-boezaart{at}


Objectives: The purpose of this case report is to describe the use of the cervical paravertebral block as the sole anesthetic for shoulder surgery in a patient unable to tolerate general anesthesia. Recent literature describes the continuous cervical paravertebral block as an effective alternative to the interscalene block for the management of postoperative pain after shoulder surgery.

Case Report: An 85-year-old man with severe respiratory and cardiac disease presented for major shoulder surgery. The patient's complex medical history required an anesthetic technique that would avoid general anesthesia and preserve phrenic nerve function. This case report describes, to our knowledge, the first successful use of the continuous cervical paravertebral block as the sole anesthetic for shoulder surgery.

Conclusions: Continuous cervical paravertebral block provided excellent surgical conditions and postoperative pain relief for this patient and allowed gradual and intermittent dosing of the catheter and continuous assessment of the anesthetic impact on respiratory function.

  • Brachial plexus block
  • Posterior approach
  • Cervical paravertebral block
  • Phrenic nerve paresis
  • Regional anesthesia
  • Local anesthetics
  • Ropivacaine

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