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Background and Aims Historically, performing bilateral interscalenic block was an absolute contraindication due to the risk of phrenic nerve paralysis. There are few cases in literature, without clear uniformity in volume and concentration of local anaesthestic, the most performed by neurostimulator. We describe a clinical case of echoguided bilateral analgesic interscalenic block for total shoulder arthroplasty, to control intense postoperative pain.

Methods We performed an interscalenic bilateral block in a 52 years old patient, ASA 2 with bilateral dislocation and fractures of proximal epiphysis of humerus. He did not have any respiratory comorbidities. The surgery was started under balanced general anesthesia, using remifentanil for analgesic management. At the end of surgery, we perform bilateral block using low volume of anaesthetic, 7 ml each side of ropivacaine 0,375%, visualizing echographically plexus roots and the spread between c5-c7.

Results The patient did not show any respiratory complication after extubation The study of diaphragm excursion did not show any phrenic disfunction. We administered multimodal analgesia without opioids needing. His Numeric Rating Scale was 0 at extubation, 3 at 12 and 24 hours from surgery. The patient had never showed signs of respiratory failure, and never had a saturation lower than 98%.

Conclusions After surgery, we only could approach brachial plexus in interscalenic site, avoiding suprascapular block because of difficult posterior approach. The use of ecography leads to reduction of volume and concentration, and could lead to deep change in classic absolute contraindications of peripheral anaesthesia.