Article Text

Download PDFPDF

B205 Phrenic-sparing anesthesia for shoulder arthroscopy in a complex polymorbid patient: a case report
  1. M Mazzocchi1,
  2. B Mascia1,
  3. D Passador1,
  4. G Bruschi1,
  5. F Riccardi1 and
  6. GA Iotti1,2
  1. 1Foundation IRCCS Polyclinic San Matteo, Pavia, Italy
  2. 2University of Pavia, Pavia, Italy


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.

Abstract B205 Table 1

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.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.