Article Text

Download PDFPDF

16 Successful regional anesthesia management for awake scapular fracture surgery: a case report
  1. E Yamak Altinpulluk1,2,3,4,
  2. D Nystad1,5,
  3. LF Valdes-Vilchesa1,6,
  4. F Gallucio1,7,
  5. I Ince1,2,4,8,
  6. T Ergonenc1,9,10,
  7. CH Salazar-Zamorano1,11 and
  8. M Fajardo-Pérez1,12
  1. 1Morphological Madrid Research Center (MoMaRC), Madrid, Spain
  2. 2Department of Outcomes Research, Cleveland Clinic, Cleveland, USA
  3. 3Cerrahpasa Medical School, Istanbul, Turkey
  4. 4Anesthesiology Clinical Research Office, Ataturk University, Erzurum, Turkey
  5. 5Anesthesiology Department, University Hospital North Norway, Narvik, Norway
  6. 6Anesthesiology Department, Hospital Costa del Sol, Agencia 54 Sanitaria Costa del Sol. Marbella, Malaga, Spain
  7. 7Dipartimento di Medicina Sperimentale e Clinica: Firenze, 60 Università degli Studi di Firenze, toscana, Italy
  8. 8Department of Anesthesiology and Reanimation, School of Medicine, Ataturk University, Erzurum, Turkey
  9. 9Department of Anesthesiology, Akyazi Pain and Palliative Care Center, Sakarya, Turkey
  10. 10Sakarya Training and Research Hospital, Sakarya, Turkey
  11. 11Anesthesiology Department, 12 de Octubre Universitary Hospital, MADRID, Spain
  12. 12Anesthesiology Department, Mostoles Universitary Hospital, Mostoles, Spain


Background and Aims Since scapula innervation are very complex, the surgery for scapular fractures usually is done under general anesthesia.1 The aim was to perform successful regional anesthesia management with mild sedation for awake scapular fracture surgery with selective target block combinations.

Methods A 77-year-old female patient with a right scapula fracture was scheduled for an open reduction and internal fixation by posterior approach at the beach-chair position. With informed consent, we performed the upper trunk block, a selective supraclavicular, and T3 thoracic paravertebral block. Upper trunk block2 at the point where it bifurcates into the suprascapular nerve/posterior and anterior division was performed with the in-plane technique and 17 mL of Ropivacaine 0.5% in a semi-sitting position in the supraclavicular fossa. (figure 1A). In this case, the supraclavicular nerve, divided into two branches, was blocked separately by 3 mL Ropivacaine 0.5%. (figure 1B) The thoracic paravertebral block at T3 with a total of 20 mL Ropivacaine 0.5% was performed at the sitting position by in the oblique sagittal in-plain technique from lateral to medial.

Results The patient was completely awake (Richmond agitation scale 0) during the surgery and no pain in the postoperative care unit. (NRS 0/10). The acetaminophen 1 g orally just once given after almost 5 hours of surgery and she was discharged home 24 hours after the surgery.

Abstract 16 Figure 1

A. Ultrasound image of Brachial Plexus, SN; suprascapular nerve, UTa; Upper trunk anterior division UTp; Upper trunk posterior division MT; medial trunk LT; Lateral trunk SA; Subclavian Artery B. Ultrasound image of two branches (from C3 and C4) of supraclavicular nerve, SCN; Supraclavicular nerve

Conclusions The selective target block combinations might be considered for all structures with complex innervation, such as scapula.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.