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Background and Aims Subclavian Transcatheter Aortic Valve Implantation (TAVI) under sedation and peripheral nerve blocks is increasingly being adopted with better outcomes when compared to general anesthesia because of reduced hemodynamic support as well as reduced pulmonary complications. We present a case of a 68-year-old woman, ASA IV, with COPD GOLD D and severe aortic stenosis admitted for a subclavian TAVI. We aim to demonstrate that the realization of regional nerve blocks facilitates subclavian access and can be safely performed with effective anesthesia and minimal respiratory risk for the patients.

Methods A single shot, ultrasound-guided, left interscalene brachial plexus (IBPB) and a superficial cervical plexus (SCPB) nerve blocks were performed using 0,375% ropivacaine (7ml for IBPB + 5ml for SCPB) in order to block the nerves that provide cutaneous innervation to the anterolateral neck and infraclavicular region. An infusion of dexmedetomidine at 1 mcg/kg/h was then induced, 10 minutes before the beginning of the procedure until the end.

Results The event was uneventful and effective anesthesia and post-op analgesia were achieved without respiratory nor hemodynamic intercurrences.

Conclusions This case successfully enhances the advantages of regional anesthesia in patients with respiratory compromise. Although there is the risk of phrenic nerve palsy secondary to IBPB, the combination of low-dose and low-volume of local anesthetic minimizes the risk, along with a proper sedation that doesn’t cause respiratory depression.