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THE ASSOCIATION OF THE ULTRASOUND-GUIDED INTERSCALENE BLOCK AND SERRATUS PLANE BLOCK AS ANAESTHETIC TECHNIQUE FOR SHOULDER SURGERY WITH POSTERIOR APPROACH. A CASE REPORT.
Author(s): ,
Scimia, P.
Affiliations:
A.S.S.T. Cremona, Department of Anaesthesia and Perioperative Medicine, Cremona, Italy
,
Giordano, C.
Affiliations:
A.S.S.T. Cremona, Department of Anaesthesia and Perioperative Medicine, Cremona, Italy
,
Basso Ricci, E.
Affiliations:
A.S.S.T. Cremona, Department of Anaesthesia and Perioperative Medicine, Cremona, Italy
,
Budassi, P.
Affiliations:
A.S.S.T. Cremona, Department of Orthopaedics and Traumatology, Cremona, Italy
Fusco, P.*
Affiliations:
San Salvatore Hospital L'Aquila, Department of Anaesthesia and Perioperative Medicine, L'Aquila, Italy
ESRA Academy. Fusco P. Sep 13, 2017; 190855; 63 Topic: Peripheral Nerve Blocks
Dr. Pierfrancesco Fusco
Dr. Pierfrancesco Fusco

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Abstract
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Background and Aims:

Traditionally, in our institution, the ultrasound-guided interscalene block (US-IB) represent the standard anaesthetic technique for shoulder surgery. However, when surgery involves the manipulation of the posterior aspect of the glenoid capsule, this technique could not provide adequate intraoperative anaesthesia, probably due to insufficient blockade of the lateral branches of the thoracic intercostal nerves. We described the association of the US-IB and Ultrasound-guided Serratus plane block (US-SPB) as a successfully anaesthetic technique for shoulder surgery with posterior approach.

Methods:

A 68 years old patient, ASA 2, scheduled to undergo open shoulder surgery to repair rotator cuff by posterior approach with transposition of the latissimus dorsi muscle. Written informed consent was obtained. In the operating room, after premedication with Midazolam 1 mg and Sufentanyl 0,1 mcg/kg, we performed the US-IB by injecting 0.5% Levobupivacaine 10 ml between C5 and C6 nerve roots. Then, an ipsilateral US-SPB was performed by injecting 0,375% Levobupivacaine 20 ml in the fascial plane between Serratus Anterior and Latissimus dorsi muscles. Intraoperative sedation was ensured with intravenously propofol 3mg/kg/h. Supplemental oxygen (4 L/min) was administered under expired CO2 control.

Results:

A reliable anesthesia of the surgical area and a good quality postoperative analgesia were obtained. In the first 48 hours after surgery, only 3 g of acetaminophen with rescue dose of ketorolac 30 mg as needed were administered. No opioids were required.

Conclusions:

This case report suggests that performing US-SPB combined to US-IB could represent an effective and safe technique for anaesthesia and postoperative analgesia in shoulder surgery with posterior approach.

    

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