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Background and Aims Fascioscapulohumeral muscular dystrophy (FSHD) predominantly affects muscles of the shoulder girdle, upper arm and face but can also affect the diaphragm resulting in restrictive lung disease. Loss of scapular muscle control limits range of shoulder movement and scapular winging may cause chronic pain. Scapulothoracic fusion aims to improve shoulder function and comfort but can be associated with significant acute postoperative pain. Pre-existing respiratory dysfunction is also exacerbated perioperatively by the application of a thoracic spica. We describe a perioperative analgesic strategy utilising regional analgesia, as an opiate sparing technique, in nine patients undergoing scapulothoracic fusion.

Methods Electronic health records were retrospectively reviewed for nine patients who underwent scapulothoracic fusion between 2019 and 2023, after obtaining verbal consent. Data were collected on anaesthetic technique and post operative morphine requirements. Oral morphine equivalent daily dosing was calculated, according to faculty of pain medicine and BNF equivalence charts in recovery, at 24 hours and 24-48hours.

Results All nine patients received an interscalene brachial plexus block (ISNB) with perineural catheter insertion and erector spinae plane (ESP) block pre-surgical start and ESP interfascial catheter at the conclusion of surgery. Four of the nine patients were using opiates prior to surgery and postoperative opiate consumption is outlined in table 1.

Conclusions Scapulothoracic fusion can be associated with significant acute postoperative pain. Preoperative ISNB and ESP blocks with post-operative ISNB perineural catheters and ESP catheters offer a useful opiate sparing analgesic adjunct in patients at high risk of postoperative pulmonary complications.