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Background and Aims Allergy to muscular relaxants is still a big concern to Anesthesiologists. This case discusses interscalene block as an alternative to General Anesthesia in a patient with confirmed allergy to Rocuronium and Cisatracurium.
Methods We report a case of 73-year-old female, ASA III, with positive skin tests to Rocuronium and Cisatracurium. Patient had a humeral fracture and was proposed for a Total Shoulder Arthroplasty. Anesthetic plan was discussed with the patient prior to the procedure and informed consent was obtained. After monitoring, the patient was given intravenous fentanyl 0,05 mg and midazolam 1mg and a dexmedetomidine perfusion was initiated. An ultrasound guided interscalene brachial plexus block (ISB) and cervical plexus block (CBP) were performed using 15 mL of ropivacaine 0,5% and mepivacaine 0,6% and 5mL of ropivacaine 0,5% and mepivacaine 0,6%, respectively. Patient was positioned in beach chair. Skin incision was made 20 minutes after local anesthetic injection. Surgery lasted for 1 hour and 30 minutes, and the patient only referred mild discomfort due to the sitting position nearly the end of the surgery. Patient controlled analgesia with intravenous morphine and ketamine was used post-operatively.
Conclusions Positivity of skin test reaction to neuromuscular blocking agents makes their use unsafe. A CPB along with an ISB can provide anesthesia to the roots C2 to C4 and C5 to C7, respectively. Together they represent an alternative anesthetic technique to General Anesthesia for shoulder surgery.