Background and Aims The interscalene nerve block is an effective analgesic technique for shoulder surgery, but a common adverse effect remains the occurrence of ipsilateral phrenic nerve block (1). In fragile patients there’s the need to identify an effective but phrenic-sparing technique.
Methods A 58yo patient with multiple comorbidities (Tab.1) and ‘frozen shoulder’ disease was scheduled for arthroscopy; his maximum right arm abduction degree was 30° and ordinary day activities were limited (he quitted working as a painter because of pain).
We performed a preoperative dynamic evaluation of phrenic activity with ultrasound that revealed impairment in left diaphragmatic function: decreased thickening fraction at rest and deep inspiration (12,5%), and decreased minimum thickening (0,16 cm).
We decided to perform a US- and ENS-guided right infraclavear block with 0,5% Ropivacaine 30 ml + suprascapular block (posterior approach) with 0.5% levobupivacaine 10 ml and dexamethasone 4mg. During the procedure, sedation was obtained by infusion of a propofol-ketamine mixture (in a 1,5:1 ratio), with no hemodynamic changes.
Results No complication occurred; there was no impairment in respiratory/coughing function, no need for intensive care recovery or support ventilation. Post-operative analgesia was obtained with acetaminophen and NSAIDS, there was no need for rescue analgesia (oxycodone).
Conclusions Infraclavear block with the association of long-lasting suprascapular block for post-operative analgesia is an effective and safe way to perform a phrenic-sparing anesthesia in complex patients at high risk for respiratory failure.
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