Background and Aims A 23-year-old male patient with epilepsy presented with bilateral shoulder fracture dislocations following a generalised tonic-clonic seizure. Multidisciplinary decision was for bilateral shoulder open reduction and internal fixation.
Bilateral interscalene blocks can lead to complete diaphragmatic paresis. To minimize this complication, we decided to perform bilateral single-shot superior (upper) trunk and interpectoral plane blocks for postoperative analgesia.
Methods A 50 mm, 20-gauge needle was used to deliver 0.375% levobupivacaine with 1:300,000 adrenaline under ultrasound guidance. The superior (upper) trunk of each brachial plexus was surrounded with 5 millilitres to avoid proximal spread to the phrenic nerve. Interpectoral plane block was then performed with 8 millilitres. Diaphragmatic paresis was assessed using ultrasound.
Results The combined regional blockade in this patient was satisfactory. Both blocks were performed without complications. The patient was extubated without any compromise of respiratory function and analgesic efficacy.
Conclusions This combined technique provided good analgesia for bilateral shoulder surgery without causing diaphragmatic paresis (1, 2).
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