Background and Aims The sensory innervation of the axilla is achieved by the brachial plexus and the intercostobrachial nerve. Hence, in patients regarded as high risk for general anesthesia, surgical interventions in the axilla require combined regional anesthesia techniques. Two previous cases describe the combination of intercostobrachial with supraclavicular brachial plexus block for axillary surgery. Others report the use of erector spinae plane block (ESPB) as postoperative analgesic approach to axillary dissection. Nevertheless, no study combines ESPB and interscalene brachial plexus block (IBPB) as anesthetic technique. This abstract aims to demonstrate their effectiveness in anesthesia and analgesia, for axillary surgery.

Methods A 68 years old woman, ASA IV, was proposed for left axillary dissection. She was regarded as high risk for general anesthesia, because she had two meningiomas, one that caused compression of the pontobulbar parenchyma and near collapse of the fourth ventricle and another that shaped the left parietal convexity. We performed an ultrasound-guided left IBPB, with 8 mL ropivacaine 0.75%, and a left ESPB at T4 level with 20 mL ropivacaine 0.375%. 50 µg of fentanyl and 1mg of midazolam were administered for sedation.

Results Fifteen minutes after ESPB, we obtained sensory block in dermatomes T1 to T8. The surgery was performed with no complications and no other anesthetics were required. The patient had no pain postoperatively and was discharged home 24h later.

Conclusions The combination of IBPB and ESPB is an effective anesthetic approach for axillary dissection. It provided complete anesthesia and long-lasting postoperative analgesia.