Selective Upper-Trunk and Axillary Nerve Block for Awake Shoulder Arthroscopy in a Pulmonary Compromised Patient: A...

Area of Science:

• Anesthesiology
• Orthopedic Surgery

Background:

• Patients with pre-existing respiratory compromise pose challenges for anesthesia during shoulder surgery.
• Options like general anesthesia or interscalene brachial plexus blocks may increase risks in these patients.

Purpose of the Study:

• To describe a safe and effective anesthetic technique for arthroscopic biceps tenodesis in a patient with severe respiratory dysfunction.
• To highlight the utility of ultrasound-guided regional anesthesia in complex surgical cases.

Main Methods:

• Ultrasound-guided selective upper-trunk block with 1% lidocaine and axillary nerve block with 0.5% ropivacaine were administered.
• Local infiltration anesthesia (LIA) with 1% lidocaine was applied at portal sites and within the shoulder capsule prior to incision.
• The patient underwent arthroscopic biceps tenodesis while awake.

Main Results:

• The anesthetic management was successful, enabling the patient to remain awake and comfortable throughout the procedure.
• The chosen regional anesthesia technique effectively managed surgical pain and avoided respiratory complications associated with general anesthesia.

Conclusions:

• Ultrasound-guided regional anesthesia, including selective nerve blocks and LIA, provides a viable alternative for managing patients with significant respiratory compromise undergoing shoulder surgery.
• This approach enhances patient safety and comfort during procedures like arthroscopic biceps tenodesis.