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Abstract
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Application for ESRA Abstract Prizes: I apply as an Anesthesiologist (Aged 35 years old or less)
Background and Aims A 59yr old male came with complaints of difficulty in left shoulder movement since 8months associated with pain. On MRI, it was diagnosed as diffuse large B cell lymphoma measuring 20X22X82mm with healed pathological fracture of left proximal humerus. He was advised for left proximal humerus excision with shoulder arthroplasty.
Methods On the day of surgery, patient was shifted to OT, monitors connected, IV cannula established. Patient did not want to undergo surgery with regional anaesthesia. Hence surgery was done under general anaesthesia. With this extensive surgery and as patient had previous history of pain, multiple blocks was planned in order to give pain relief postoperatively.
Results 0.25% bupivacaine was used in multiple ultrasound-guided blocks for analgesia and later extubated. -10ml used for selective upper trunk brachial plexus block to target dorsal scapular nerve and lower subscapular nerve. -5ml used for superficial cervical plexus block to target supraclavicular nerve. -15ml used for supraclavicular brachial plexus block to provide analgesia to area supplied by lateral pectoral nerve, suprascapular nerve and axillary nerve. -5ml given as intra-articular infiltration posteriorly as posterior part of shoulder have high concentration of mechanoreceptors. Additive Inj. Dexamethasone 6mg IV given to prolong the analgesia. Post-Operative patient had a VAS score of 1/10 and continued to have pain relief for the next 36hours.
Postoperative left shoulder X-ray
Conclusions Multiple blocks was administered for this complicated shoulder surgery to provide adequate analgesia for the patient.