16 Successful regional anesthesia management for awake scapular fracture surgery: a case report

Background and Aims Since scapula innervation are very complex, the surgery for scapular fractures usually is done under general anesthesia.1 The aim was to perform successful regional anesthesia management with mild sedation for awake scapular fracture surgery with selective target block combinations. Methods A 77-year-old female patient with a right scapula fracture was scheduled for an open reduction and internal fixation by posterior approach at the beach-chair position. With informed consent, we performed the upper trunk block, a selective supraclavicular, and T3 thoracic paravertebral block. Upper trunk block2 at the point where it bifurcates into the suprascapular nerve/posterior and anterior division was performed with the in-plane technique and 17 mL of Ropivacaine 0.5% in a semi-sitting position in the supraclavicular fossa. (figure 1A). In this case, the supraclavicular nerve, divided into two branches, was blocked separately by 3 mL Ropivacaine 0.5%. (figure 1B) The thoracic paravertebral block at T3 with a total of 20 mL Ropivacaine 0.5% was performed at the sitting position by in the oblique sagittal in-plain technique from lateral to medial. Results The patient was completely awake (Richmond agitation scale 0) during the surgery and no pain in the postoperative care unit. (NRS 0/10). The acetaminophen 1 g orally just once given after almost 5 hours of surgery and she was discharged home 24 hours after the surgery. Conclusions The selective target block combinations might be considered for all structures with complex innervation, such as scapula.