Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page)

Background and Aims Regional analgesia and anesthesia for shoulder disarticulation can be achieved by sensory blockade between C4 and T4 dermatomes . Here, we present a report of a patient with severe upper extremity pain and poor respiratory function who underwent unilateral shoulder disarticulation using regional blocks for surgical anesthesia.

Methods An 80-year-old woman presenting with angiosarcoma associated with lymphedema was admitted. Due to the large size of the tumor and intractable pain, shoulder disarticulation surgery was planned. Considering the comorbidities of the case (chronic pulmonary disease, hypertension) we attempted to perform surgery under regional anesthesia. Written consent was obtained after informing the patient about the procedures to be performed and published. We performed the bilevel thoracic intertransverse process (ITP) blocks at the level of the T1/T3 transverse processes in addition to the superficial cervical and interscalene brachial plexus blocks.

Results Thirty minutes after the injections, the sensory blockade was assessed by the pinprick method in the C4 to T4 dermatomal areas. Amputation was performed through the shoulder joint, and the humeral head was disarticulated from the glenoid in the lateral decubitus position. The patient remained conscious during the operation (90 min). The average NRS score within the first 24 hours was 2 to 10 (range, 1–4).

Conclusions The present report demonstrated that the combination of cervical plexus,interscalene and ITP blocks can be used as an alternative method to general anesthesia for shoulder disarticulation surgery in comorbid patients. Further prospective studies are needed to evaluate the feasibility of this approach.