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ALTERNATIVE BLOCKS FOR SHOULDER SURGERY IN A PATIENT WITH BILATERAL VOCAL CORD PARALYSIS
Author(s): ,
Antunes , C.
Affiliations:
Hospital Senhora da Oliveira Guimarães, Hospital Senhora da Oliveira Guimarães, Guimarães, Portugal
,
Jesus , T.*
Affiliations:
Hospital Senhora da Oliveira Guimarães, Hospital Senhora da Oliveira Guimarães, Guimarães, Portugal
,
Vieira , D.
Affiliations:
Hospital Senhora da Oliveira Guimarães, Hospital Senhora da Oliveira Guimarães, Guimarães, Portugal
,
Ferreira , S.
Affiliations:
Hospital Senhora da Oliveira Guimarães, Hospital Senhora da Oliveira Guimarães, Guimarães, Portugal
,
Coutinho , A.
Affiliations:
Hospital Senhora da Oliveira Guimarães, Hospital Senhora da Oliveira Guimarães, Guimarães, Portugal
Magalhães , J.
Affiliations:
Hospital Senhora da Oliveira Guimarães, Hospital Senhora da Oliveira Guimarães, Guimarães, Portugal
ESRA Academy. Martins Carvalho Jesus T. Sep 13, 2017; 190709
Dr. Tiago Filipe Martins Carvalho Jesus
Dr. Tiago Filipe Martins Carvalho Jesus

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Abstract
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Background and Aims:

Shoulder surgery can result in significant postoperative pain. Interscalene brachial plexus block (ISBs) still represent the goldstandard approach for analgesia, however, when contraindicated, regional anesthesiologist have to choose alternative nerve blocks, namely axillary (AN) – and suprascapular (SSN) that may provide effective analgesia for minor shoulder surgery.

Methods:

The authors present a 33-year-old female scheduled for shoulder arthroscopy. She had bilateral vocal cord paralysis after total thyroidectomy. The anesthesiologist performed a suprascapular and axillary ultrasound guided nerve block with total dose 75 mg of 0.5% ropivacaine. 

Results:

The surgery was carried out under general anesthesia in the lateral decubitus position, lasted 90 minutes and was uneventfully. In the end of the procedure, the patient was comfortable, able to talk normally and denied dyspnea. She was discharged home the next day, indicating no pain or need for rescue analgesia.

Conclusions:

Postoperative pain management represents a relevant field in shoulder surgery and regional analgesia plays here an important role. The ISB has been associated with some potential side effects, such as incidental paralysis of the vagus and laryngeal recurrent nerves. The combination of SSN and AN blocks was used effectively for analgesia in shoulder arthroscopy, and revealed a valid and very safe option in analgesia for intraoperative and early postoperative period, in a patient with bilateral vocal cord paralysis.

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