The upper extremity regional anaesthesia trifecta: three upper extremity nerve blocks for awake upper‐limb surgery in a patient with a history of contralateral pneumonectomy*

Abstract

Summary While regional anaesthesia plays a pivotal role in the perioperative management of patients undergoing upper extremity surgery, its utility can be limited by the risk of hemi‐diaphragmatic paresis. Furthermore, each approach to blocking the brachial plexus has associated limitations that may result in incomplete upper extremity anaesthesia. We describe the combination of three upper extremity nerve blocks to achieve surgical anaesthesia of the whole arm for a patient who had previously undergone a contralateral pneumonectomy. On this occasion, she required upper arm lipectomy and arteriovenous fistula formation. Adequate blockade was achieved with no significant perioperative complications. This case demonstrates the potential of this approach for patients with respiratory compromise undergoing upper limb procedures.

The analgesic effect of ultrasound-guided cervical erector spinae block in arthroscopic shoulder surgery: a randomized controlled clinical trial

“…Several analgesic methods and techniques have been employed for perioperative pain management in arthroscopy shoulder surgery, including patient-controlled intravenous analgesia (PCIA), interscalene brachial plexus and local infiltration anesthesia [ 4 ]. These analgesic methods have their own advantages, but they also carry the risk of inadequate analgesia, and can cause some serious complications, such as phrenic nerve block, dyspnea, central neuraxial nerve injury, and Horner’s syndrome, limiting their use in certain populations [ 5 , 6 ]. Therefore, it is urgent to explore a more effective and safe analgesic method following arthroscopy shoulder surgery.…”