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155 Superior trunk block: an unorthodox alternative to interscalene block for proximal humerus surgeries in patients with significant pulmonary disease
  1. R Darshan,
  2. RS Mane and
  3. MC Patil
  1. Kaher’s Jawaharlal Nehru Medical College, Belagavi, India


Background and Aims Proximal shoulder surgery in patients with compromised pulmonary function stipulates anaesthesiologists to look for an alternative to interscalene block. Such aforementioned challenge pioneered the initiation of use of superior trunk block to utilise distinct advantage of phrenic nerve sparing, allowing the patients to execute normal respiratory functions perioperatively. Superior trunk of brachial plexus visualised accurately through ultrasound, steers effortless performance and achieving acceptable block characteristics.

Methods Here we present a case series of 8 patients aged between 40 years to 80 years with significant restrictive, obstructive pulmonary disease and post-covid patients posted for proximal humerus surgeries. The block was performed under ultrasound guidance, 23G Quincke spinal needle, 1:1 local anaesthetic mixture of 2% Lignocaine+Adrenaline and 0.5% Bupivacaine with total volume injected being 15 ml. The outcomes measured were loss of shoulder abduction, numbness of shoulder and pain relief, numbness of arm and sonographic assessment of diaphragm movement, oxygen saturation perioperatively and closed-circuit measurement of tidal volume generated

Results 7 patients with superior trunk block achieved complete surgical anaesthesia of proximal shoulder. There was solitary use of Dexmedetomidine for patient with severe anxiety. 2 patients required oxygen supplementation throughout the intraoperative period extending to post-operative period as well. Sonographic assessment intraoperatively and post-operatively disclosed adequate diaphragmatic excursion in all patients. Post-operative pain scores revealed satisfactory pain relief.

Conclusions Effective surgical anaesthesia and analgesia can be delivered considerably with Superior trunk block for surgeries of proximal humerus in patients with compromised pulmonary function by sparing phrenic nerve and it is an appropriate substitute for interscalene block

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