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Supraclavicular Block as a Sole Anesthetic Technique in Craniopagus Twins
  1. Laura E. Schleelein, MD,
  2. Alison R. Perate, MD and
  3. Arjunan Ganesh, MBBS
  1. Department of Clinical Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania and The Children’s Hospital of Philadelphia, Philadelphia, PA.
  1. Address correspondence to: Laura E. Schleelein, Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia, 34th St and Civic Center Blvd, Main Bldg, 9th Floor, Suite 9329, Philadelphia, PA 19104 (e-mail: schleelein{at}


Abstract This is the first report in the literature of a sole regional anesthetic for adult craniopagus twins using a supraclavicular block for an elbow incision and drainage/bursa excision procedure. It demonstrates that for these complex medical patients, a total regional anesthesia technique is preferable when possible. There are several known general anesthetic complications in these patients. Anesthetic crossover between the twins can occur and may be variable; furthermore, the incidence and severity of the crossover effects of different anesthetics vary. Positioning of the twins can be difficult with both regional and general anesthesia. However, with regional anesthesia, the twins can position themselves and report any discomfort, which could go unnoticed under general anesthesia, leading to other complications. Craniopagus twins have a high likelihood of a difficult airway due to anatomy or positioning difficulties, which is avoided by regional anesthesia. This case emphasizes the unique challenges that these patients pose and the ability of regional anesthesia to help avoid the pitfalls of general anesthesia in these patients.

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  • This work is attributed to the Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia.

    Department funds were used from the Department of Anesthesiology and Critical Care Medicine at The Children’s Hospital of Philadelphia.

    This work was presented at the Society of Pediatric Anesthesiology, February 25, 2012, Tampa, FL.

    The authors declare no conflict of interest.

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