Background and Aims Analgesia after shoulder surgery remains a major challenge. Alternative phrenic sparing techniques for post-operative shoulder analgesia like the shoulder block (suprascapular and axillary nerve blocks) have been advocated. Nevertheless, as shoulder innervation is complex, shoulder block may provide an incomplete blockade and two punctures are needed, so other options are still been searched. Costoclavicular brachial plexus block (CCBPB) was presented as a valid option carrying only 2.5% of phrenic paralysis, against 39.8% with interscalene approach1.

We intend to increase awareness to CCBPB as a safe and effective phrenic sparing technique for shoulder surgery.

Methods Case report and literature review.

Results A 64-years-old patient, ASA III due Diabetes Mellitus, peripheral venous insufficiency, dyslipidemia, obesity and history of snoring, was admitted for shoulder surgery. An ultrasound guided CCBPB was performed instead of an interscalene or supraclavicular approach to minimize the risk of phrenic nerve hemiparesis. Ropivacaine 0.375% was administered. The patient reported generalized upper limb sensitive block, while maintaining motor capacity after 5 minutes. Then, general anesthesia was induced. Surgery was uneventful. Despite no conventional analgesia has been given before emergence, 0.4 mg of naloxone was needed to recover spontaneous ventilation. After emergence she denied pain, only referring sensitive and motor block of upper limb. Rescue analgesia was not needed.

Conclusions CCBPB mode of action relies on the local anesthetic (LA) retrograde dispersion within the costoclavicular canal, with only one injection, which allows: blocking of the main nerves involved in shoulder innervation and lower risks of phrenic block and suprascapular nerve block sparing2.