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Background and Aims Interscalene brachial plexus block (ISB) has been used for analgesia and surgical anaesthesia.for surgeries on the shoulder. Phrenic nerve involvement following an ISB causes hemi diaphragmatic paralysis (HDP). A combination of anterior suprascapular nerve block (SSB) and costoclavicular nerve block (CCB) have been used for postoperative analgesia. Their ability to achieve surgical anaesthesia without phrenic nerve involvement needs further evaluation. We report two cases of open fixation of proximal fracture of the humerus done under a combination of an anterior SSB and CCB as sole anaesthetic without any evidence of phrenic nerve involvement..
Methods 75 years old male, chronic smoker with COPD, bronchial asthma, old pulmonary tuberculosis, lung fibrosis and chronic atrial fibrillation and pulmonary hypertension of 40 mmHg. 55 years old male with Multiple Myeloma and COPD on BIPAP support. Both patients had poor effort tolerance and low room air saturation. Both patients received dual modality ie. Ultrasonography and Nerve stimulator guided combined anterior SSB and CCB. 10ml 2% Inj.Xylocard and 20ml 0.375% Inj.Ropivacaine were given .USG of the diaphragm done in both patients postoperatively showed no change in the diaphragmatic excursion when compared to the opposite side diaphragm. Shortcoming of this report is that the diaphragm excursions were not assessed before the blocks were done
Conclusions Anterior SSB and CCB can be considered as sole anaesthetic for shoulder surgeries in patients with underlying pulmonary pathology and compromised respiratory function
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