Bilateral ultrasound-guided supraclavicular block

Abstract

Analgesic management in patients with bilateral trauma to the shoulder or the proximal third of the arm is difficult. The multimodal strategy based on the administration of local analgesics to the brachial plexus appears to be the most effective; however, there are risks associated with bilateral blocks, including phrenic nerve palsy, toxicity due to local anesthetics, and bilateral pneumothorax. These risks may be diminished using an ultrasound-guided supraclavicular approach to the brachial plexus.This paper describes the management of a patient with bilateral injury to the shoulder and the proximal third of the humerus. The patient is taken to bilateral humeral fixation surgery and develops severe post-operative pain which does not respond to high-dose opioids and anti-inflammatory agents. He is managed initially with bilateral ultrasound-guided supraclavicular block using a low volume of a local anesthetic followed by continuous administration of bupivacaine. Pain assessment was 2/10 at 24h and 3/10 at 48h.We concluded that bilateral supraclavicular blockade is an option in the acute management of pain after surgery to the shoulder and the proximal third of the humerus. Continuous administration of local anesthetics to the brachial plexus helps maintain the analgesic response.