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Background and Aims Scapula fractures are uncommon and are usually caused by high energy trauma which are often associated with intrathoracic injury. Treatment is usually nonoperative with imoblization or a sling and rarely requires surgery. This case study aims to discuss a potential regional approach for patients with scapular fractures needing operative repair. Our patient is an 81 year old female with past medical history of obesity (BMI 36), hypertension, coronary artery disease, chronic kidney disease, gastroesophageal reflux, depression, and osteoporosis who presented with a stress fracture at the base of the acromion process of her right scapular from a fall that failed conservative, nonoperative management. She was scheduled for an elective open reduction and internal fixation via posterior approach.
Methods The case began with regional anesthesia. She received a total of 25mL of 0.5% ropivacaine with 60mcg dexmedetomidine for three blocks: interscalene brachial plexus, superficial cervical plexus, and suprascapular nerve blocks. The case proceeded with general endotracheal anesthesia without event.
Results In PACU, she reported 0/10 pain, without needing any postoperative narcotics prior to her discharge home.
Conclusions For a posterior approach scapula surgery involving the acromion, a combination of interscalene brachial plexus, superficial cervical plexus, and suprascapular nerve blocks are appropriate for acute pain management of these patients.
Attachment Superficial Cervical Plexus Block.jpg
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