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Yadav H, Gera S, Sehgal L, Minhas V. Regional anaesthesia for major orthopaedic trauma surgery in patients with conservatively managed pneumothoraces. Anaesth Rep 2024; 12:e12299. [PMID: 38737502 PMCID: PMC11087673 DOI: 10.1002/anr3.12299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2024] [Indexed: 05/14/2024] Open
Abstract
The anaesthetic management of multiple traumatic injuries poses numerous challenges. In this report, we present the cases of two patients with polytrauma including pneumothoraces and multiple rib fractures. The first patient, a 39-year-old man, presented with multiple left upper limb fractures, multiple bilateral rib fractures, bilateral pneumothoraces and fractures of multiple facial and cranial bones. The second patient, a 39-year-old woman, presented with right-sided radial and ulnar fractures, a right-sided pelvic fracture, and multiple right-sided rib fractures with an associated pneumothorax. We used ultrasound-guided superficial cervical plexus, interscalene and supraclavicular blocks in the first case and a combined spinal and epidural after ultrasound-guided fascia iliaca and supraclavicular blocks in the second case. In both cases, the use of multiple regional techniques allowed us to avoid the risks of general anaesthesia in patients with conservatively managed pneumothoraces.
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Affiliation(s)
- H. Yadav
- Department of Liver Transplant AnaesthesiaHuman Care Medical Charitable Trust Manipal HospitalNew DelhiIndia
| | - S. Gera
- Department of AnaesthesiaRao Tula Ram Memorial HospitalNew DelhiIndia
| | - L. Sehgal
- Department of Liver Transplant AnaesthesiaHuman Care Medical Charitable Trust Manipal HospitalNew DelhiIndia
- Liver Intensive Care UnitHuman Care Medical Charitable Trust Manipal HospitalNew DelhiIndia
| | - V. Minhas
- Department of AnaesthesiaNMC Royal HospitalDubaiUnited Arab Emirates
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Arnaut DA, Maltbia T, Sadeghipour H. Continuous Interscalene Nerve Block for a Midshaft Clavicle Fracture: An Opioid-Sparing Postoperative Analgesic Strategy. Cureus 2023; 15:e49027. [PMID: 38116355 PMCID: PMC10728011 DOI: 10.7759/cureus.49027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2023] [Indexed: 12/21/2023] Open
Abstract
Postoperative pain after surgical clavicle fixation is difficult to treat and often responds incompletely to opioid analgesics. Unfavorable side effects and the risk of misuse of opioid analgesics make regional anesthetic techniques an attractive strategy for treating clavicular pain. Literature on continuous nerve blocks with catheter placement for more prolonged pain control for clavicle fractures is scarce, while such techniques are common for other shoulder surgeries. This case report presents a successful continuous interscalene brachial plexus block (ISB) after surgical fixation of a midshaft clavicle fracture. The patient was discharged home on the day of the operation with a portable pump, which provided a local anesthetic infusion for five days postoperatively. The patient was very satisfied with her pain control and only required one dose of oral opioid analgesic postoperatively.
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Affiliation(s)
- Daniel A Arnaut
- Anesthesiology and Critical Care, Saint Louis University School of Medicine, Saint Louis, USA
| | - Theodis Maltbia
- Anesthesiology and Critical Care, Sisters of St. Mary (SSM) Saint Louis University Hospital, Saint Louis, USA
| | - Hamed Sadeghipour
- Anesthesiology and Critical Care, Sisters of St. Mary (SSM) Saint Louis University Hospital, Saint Louis, USA
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Patel H, Shah N, Syed A, Shah P, Macwan S. Evaluating the Analgesic Efficacy of Superficial Cervical Plexus Block for Head and Neck Surgeries: A Comparative Randomized Control Study. Cureus 2023; 15:e39303. [PMID: 37346207 PMCID: PMC10281613 DOI: 10.7759/cureus.39303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2023] [Indexed: 06/23/2023] Open
Abstract
INTRODUCTION In the present study, the advantages of superficial cervical plexus block (SCPB) were evaluated using a landmark-guided method. Our primary aim was to evaluate the analgesic efficacy of SCPB in various head and neck surgeries by observing intra- and postoperative requirements of the total dose of the systemic analgesic, visual analog scale (VAS) score, and the total duration of analgesia; vital parameters and associated perioperative complications were also observed. MATERIALS AND METHODS Sample size was calculated using reference by taking the parameter pain score at 12 hours using MedCalc software v. 19.5.1 (MedCalc Software, Ostend, Belgium) with a mean difference of score 3±3.5 between two groups, 80% power, and 95% confidence interval (CI); the sample size for each group was 21. There were 30 patients in each group of ASA I, II, and III who were posted for mandibular, tympanomastoid and clavicular surgeries. Group A received general anaesthesia with systemic analgesia and Group B received general anaesthesia followed by SCPB with an injection of bupivacaine 0.25% 10ml on each side according to the site of surgery. VAS score, intra and postoperative analgesic requirement in 24 hours, time of first demand bolus, and peri-operative complications were noted. RESULTS Intraoperative fentanyl requirement for group A was 97.5±13.75 µg as compared to group B (70.16±13.09 µg), postoperative injection paracetamol requirement was also significantly higher in group A (2566.66±504 mg) as compared to group B (833.33±874.28 mg). The total duration of analgesia was significantly higher in Group B (1191.33±375.36 min) as compared to Group A (122.0±50.88 min) with a p-value <0.0001. No significant complications were noted in any patient. CONCLUSION SCPB provides better perioperative analgesia by decreasing intraoperative as well as postoperative systemic analgesic requirements and their associated side effects, with no significant perioperative complications in various head and neck region surgeries.
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Affiliation(s)
- Himani Patel
- Department of Anaesthesia, Government Medical College, Sir Sayajirao General Hospital, Vadodara, IND
| | - Neha Shah
- Department of Anaesthesia, Government Medical College, Sir Sayajirao General Hospital, Vadodara, IND
| | - Afroza Syed
- Department of Anaesthesia, Government Medical College, Sir Sayajirao General Hospital, Vadodara, IND
| | - Panjari Shah
- Department of Anaesthesia, Government Medical College, Sir Sayajirao General Hospital, Vadodara, IND
| | - Sharmy Macwan
- Department of Anaesthesia, Government Medical College, Sir Sayajirao General Hospital, Vadodara, IND
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Lee CCM, Beh ZY, Lua CB, Peng K, Fathil SM, Hou JD, Lin JA. Regional Anesthetic and Analgesic Techniques for Clavicle Fractures and Clavicle Surgeries: Part 1-A Scoping Review. Healthcare (Basel) 2022; 10:1487. [PMID: 36011144 PMCID: PMC9408139 DOI: 10.3390/healthcare10081487] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 07/28/2022] [Accepted: 07/29/2022] [Indexed: 11/17/2022] Open
Abstract
Objective. Clavicle fractures are common injuries potentially associated with significant perioperative pain. However, this region's complex sensory innervation poses a challenge for regional anesthetic or analgesic (RA) techniques. We conducted this scoping review to summarize the current literature, particularly with regards to motor-sparing techniques. Methods. A scoping review was carried out in accordance with the Joanna Briggs Institute's framework. All articles describing the use of RA for clavicle fractures or surgery were included. PubMed®, Ovid MEDLINE®, EMBASE®, Scopus®, CINAHL®, and the Cochrane database were searched without language restrictions. Results. Database searches identified 845 articles, 44 of which were included in this review, with a combined patient total of 3161. We included all peer-reviewed publications containing clinical data and summarized the findings. Conclusions. Current evidence of RA techniques in clavicle surgery is heterogeneous, with different approaches used to overcome the overlapping sensory innervation. The literature largely comprises case reports/series, with several randomized controlled trials. Intermediate cervical plexus block is the regional technique of choice for clavicle surgery, and can provide reliable surgical anesthesia when combined with an interscalene block. Cervical plexus block can provide motor-sparing analgesia following clavicle surgery. Promising alternatives include the clavipectoral block, which is a novel motor-sparing regional technique. Further studies are required to determine the efficacy and safety of various techniques.
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Affiliation(s)
- Chang Chuan Melvin Lee
- Department of Anesthesia, Toowoomba Base Hospital, Darling Downs Hospital and Health Service, Brisbane, QLD 4350, Australia
- Rural Clinical School, Toowoomba Regional Clinical Unit, University of Queensland, Brisbane, QLD 4350, Australia
- Department of Anesthesia, National University Health System, Singapore 119074, Singapore
- Center for Regional Anesthesia and Pain Medicine, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
| | - Zhi Yuen Beh
- OSC Orthopaedic Specialist Centre, Subang Jaya 47600, Malaysia
- Department of Anesthesiology, Assunta Hospital, Petaling Jaya 46990, Selangor, Malaysia
| | - Chong Boon Lua
- Department of Anesthesia, National University Health System, Singapore 119074, Singapore
| | - Kailing Peng
- Department of Anesthesia, National University Health System, Singapore 119074, Singapore
| | - Shahridan Mohd Fathil
- Department of Anesthesiology, Gleneagles Hospital Medini, Nusajaya 79250, Malaysia
- Center for Regional Anesthesia and Pain Medicine, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan
| | - Jin-De Hou
- Division of Anesthesiology, Hualien Armed Forces General Hospital, Hualien 97144, Taiwan
- Department of Anesthesiology, School of Medicine, National Defense Medical Center, Taipei 11490, Taiwan
| | - Jui-An Lin
- Center for Regional Anesthesia and Pain Medicine, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
- Center for Regional Anesthesia and Pain Medicine, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan
- Department of Anesthesiology, School of Medicine, National Defense Medical Center, Taipei 11490, Taiwan
- Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- Pain Research Center, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan
- Department of Anesthesiology, School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- Department of Anesthesiology, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
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Cai Q, Han Y, Gao M, Ni S. Analysis of the Effect of Applying Ultrasound-Guided Nerve Block Anesthesia to Fracture Patients in the Context of Internet-Based Blockchain. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:6324009. [PMID: 35463653 PMCID: PMC9023192 DOI: 10.1155/2022/6324009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 02/27/2022] [Accepted: 02/28/2022] [Indexed: 11/25/2022]
Abstract
In the process of surgical treatment, the introduction of ultrasound technology to implement nerve block anesthesia can make the operations of patients with fractures under visualization and it can also significantly improve the anesthesia effect. With this technology, it is possible to minimize the anesthesia operation causing accidental injury and lay a good foundation for the smooth operation of surgical treatment. Blockchain technology is a new decentralized infrastructure and distributed computing paradigm. This technology has great development opportunities in the medical field and is expected to play an important role in the construction of Internet medical ecology. This study aims to investigate the effect of ultrasound-guided nerve block anesthesia on fracture treatment in the context of blockchain. This method has high application value and potential in medical data sharing, reducing treatment costs, improving the medical claims system, strengthening medical management, and optimizing medical decision-making using blockchain technology. This study also addresses the uniqueness and complexity of ultrasound-guided nerve block anesthesia itself and analyzes the effect of the proposed method. The analysis shows that using the internet-based blockchain ultrasound-guided subacromial nerve block anesthesia for fracture patients is effective, and the patient's vital signs are stable, and the block is effective.
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Affiliation(s)
- Qiang Cai
- Department of Orthopedics, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang 441000, Hubei, China
| | - Yi Han
- Department of Anesthesiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Meiling Gao
- Department of Anesthesiology, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, Hubei, China
| | - Shuqin Ni
- Department of Anesthesiology, Yantaishan Hospital, Yantai 264003, Shandong, China
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Beletsky A, Burton BN, Swisher MW, Finneran IV JJ, Gabriel RA. Utilization of regional anesthesia for open reduction and internal fixation of clavicular fractures is associated with increased same-day discharge and not readmissions. Reg Anesth Pain Med 2020; 45:716-719. [DOI: 10.1136/rapm-2020-101567] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/15/2020] [Accepted: 06/18/2020] [Indexed: 11/04/2022]
Abstract
BackgroundRegional anesthesia is becoming increasingly used for analgesia in clavicular surgery. The purpose of the study is to examine same-day discharge and readmissions in patients with clavicular fractures receiving open reduction and internal fixation, comparing those who received regional anesthesia to those that did not.MethodsThe National Surgical Quality Improvement Program registry was used to build a retrospective cohort with the primary and secondary outcomes of same-day discharge and readmission rates, respectively. The independent variable was type of anesthesia (ie, regional vs general). Unadjusted univariable followed by multivariable logistic regression analysis for the association of each covariate with the primary and secondary outcome was performed. A p<0.05 was considered statistically significant.ResultsA total of 2300 patients were included, in which 346 (15.0%) of received a nerve block. The only factor associated with same-day discharge on crude analysis was the use of a nerve block (OR 1.70, 95% CI 1.21 to 2.40, p<0.01). Factors not associated with same-day discharge included geriatric age (OR 0.39, 95% CI 0.26 to 0.57, p<0.01), diabetes mellitus (OR 0.54, 95% CI 0.33 to 0.89, p=0.01), dependent functional status (OR 0.27, 95% CI 0.11 to 0.69, p<0.01), hypertension (OR 0.39, 95% CI 0.29 to 0.52, p<0.01), bleeding disorder (OR 0.24, 95% CI 0.10 to 0.59, p<0.01) and an American Society of Anesthesiologists Physical Status score ≥3 (OR 0.33, 95% CI 0.25 to 0.45, p<0.01). On adjusted analysis, regional anesthesia was associated with increased odds of same-day discharge (OR 1.67, 95% CI 1.18 to 2.37, p<0.01), but not 30-day readmission (OR 0.57, 95% CI 0.13 to 2.52, p=0.46).ConclusionRegional anesthesia use in patients with clavicular fractures is associated with higher odds for same-day discharge. There is no significant difference in the rates of hospital readmission within a 30-day period.Level of EvidenceIV, retrospective case series.
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Kim HY, Soh EY, Lee J, Kwon SH, Hur M, Min SK, Kim JS. Incidence of hemi-diaphragmatic paresis after ultrasound-guided intermediate cervical plexus block: a prospective observational study. J Anesth 2020; 34:483-490. [PMID: 32236682 DOI: 10.1007/s00540-020-02770-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 03/21/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE An intermediate cervical plexus block (CPB) targets the posterior cervical space between the sternocleidomastoid muscle and the prevertebral fascia. The phrenic nerve descends obliquely on the surface of the anterior scalene muscle beneath the prevertebral fascia after originating from the C3-C5 ventral rami. Therefore, the phrenic nerve can be affected by a local anesthetic during an intermediate CPB, depending on the permeability characteristics of the prevertebral fascia. This study investigated whether an intermediate CPB affects the phrenic nerve, inducing hemidiaphragmatic paresis. METHODS In this prospective observational study, 20 patients undergoing single-incision transaxillary robot-assisted right thyroidectomy were enrolled. The intermediate CPB (0.25% ropivacaine 0.2 ml/kg) was performed at the C4-5 intervertebral level carefully, without penetrating the prevertebral fascia, before the patient emerged from general anesthesia. Diaphragmatic motions of the block side were measured by M-mode ultrasonography at three time points: before anesthesia (baseline) and at 30 and 60 min after the intermediate CPB. Hemidiaphragmatic paresis was divided into three grades, depending on the percentage of diaphragm movement compared to the baseline: none (> 75%), partial paresis (25-75%), and complete paresis (< 25%). RESULTS No patient showed any partial or complete ipsilateral hemidiaphragmatic paresis within 60 min after the intermediate CPB. CONCLUSION Intermediate CPB using 0.2 ml/kg of 0.25% ropivacaine at the C4-5 intervertebral level did not cause ipsilateral hemidiaphragmatic paresis. This may imply that the effect of the intermediate CPB on the phrenic nerve is not significant.
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Affiliation(s)
- Ha Yeon Kim
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, 164 Worldcup-ro Yeongtong-gu, Suwon, 16499, Republic of Korea
| | - Euy Young Soh
- Department of Surgery, Ajou University School of Medicine, 164 Worldcup-ro Yeongtong-gu, Suwon, 16499, Republic of Korea
| | - Jeonghun Lee
- Department of Surgery, Ajou University School of Medicine, 164 Worldcup-ro Yeongtong-gu, Suwon, 16499, Republic of Korea
| | - Sei Hyuk Kwon
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, 164 Worldcup-ro Yeongtong-gu, Suwon, 16499, Republic of Korea
| | - Min Hur
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, 164 Worldcup-ro Yeongtong-gu, Suwon, 16499, Republic of Korea
| | - Sang-Kee Min
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, 164 Worldcup-ro Yeongtong-gu, Suwon, 16499, Republic of Korea
| | - Jin-Soo Kim
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, 164 Worldcup-ro Yeongtong-gu, Suwon, 16499, Republic of Korea.
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Banerjee S, Acharya R, Sriramka B. Ultrasound-Guided Inter-scalene Brachial Plexus Block with Superficial Cervical Plexus Block Compared with General Anesthesia in Patients Undergoing Clavicular Surgery: A Comparative Analysis. Anesth Essays Res 2019; 13:149-154. [PMID: 31031496 PMCID: PMC6444954 DOI: 10.4103/aer.aer_185_18] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background: General anesthesia is preferred for clavicular surgeries. With the advent of ultrasound-guided technology, interscalene brachial plexus block with superficial cervical nerve block has become a new option for providing intraoperative anesthesia and postoperative analgesia for surgeries of the clavicle. Aims and Objectives: The present study compares the ultrasound-guided interscalene brachial plexus nerve block combined with superficial cervical nerve block to general anesthesia in clavicular surgery. Settings and Design: This study was a randomized controlled trial in a tertiary care setting. Materials and Methods: A total of 60 patients between 18 and 60 years who were scheduled for clavicular surgeries were randomly and equally divided into Group B and Group G. Group B received ultrasound-guided interscalene brachial plexus block with superficial cervical nerve block. Group G received general anesthesia. Time duration between start of anesthesia to the incision time, intraoperative vitals, and time spent in postanesthesia care unit, postoperative pain scores, postoperative analgesic consumption, and complications were noted and compared. Statistical Analysis: Statistical analyses were done using SPSS software 20.0. Normality tests were applied, and accordingly, parametric and nonparametric tests were used to calculate the results. Results: The demographic data were comparable in both the groups. Time duration between start of anesthesia to the incision time was significantly more in Group B than in Group G. The time spent in postanesthesia care unit and postoperative pain scores were significantly more in Group G than Group B. Total postoperative opioid consumption was significantly less in Group B than in Group G. Conclusion: Ultrasound-guided interscalene brachial plexus block combined with superficial cervical nerve block is a safe and effective mode of anesthesia in comparison to general anesthesia for clavicle surgeries.
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Affiliation(s)
- Swarna Banerjee
- Department of Anesthesia, IMS and SUM Hospital, Bhubaneswar, Odisha, India
| | - Ranjita Acharya
- Department of Anesthesia, IMS and SUM Hospital, Bhubaneswar, Odisha, India
| | - Bhavna Sriramka
- Department of Anesthesia, IMS and SUM Hospital, Bhubaneswar, Odisha, India
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Baran O, Kır B, Ateş İ, Şahin A, Üztürk A. Combined supraclavicular and superficial cervical plexus block for clavicle surgery. Korean J Anesthesiol 2018; 73:67-70. [PMID: 30481946 PMCID: PMC7000276 DOI: 10.4097/kja.d.18.00296] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 11/25/2018] [Indexed: 12/31/2022] Open
Abstract
Background Clavicle fractures occur in 35% of shoulder girdle fractures. Surgical fixation is preferred, especially in young patients for optimal functional outcomes, while nondisplaced fractures are usually treated conservatively. Case A 38-year-old male patient was admitted to the emergency services with a fracture of the left clavicle following a fall. During the preoperative evaluation, the patient requested to be awake during the surgery. Combined supraclavicular and superficial cervical plexus block was performed under ultrasound guidance without complications and the patient experienced no pain. Conclusions This technique may avoid possible complications related to interscalene brachial plexus block. Future studies are required to confirm the safety and efficacy of this approach.
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Affiliation(s)
- Onur Baran
- Clinic of Anesthesiology and Reanimation, Palandöken State Hospital, Erzurum, Turkey
| | - Bünyamin Kır
- Clinic of Anesthesiology and Reanimation, Palandöken State Hospital, Erzurum, Turkey
| | - İrem Ateş
- Clinic of Anesthesiology and Reanimation, Palandöken State Hospital, Erzurum, Turkey
| | - Ayhan Şahin
- Department of Anesthesiology and Reanimation, Medical Faculty of Namık Kemal University, Tekirdağ, Turkey
| | - Ali Üztürk
- Clinic of Orthopedics and Traumatology, Palandöken State Hospital, Erzurum, Turkey
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