Low-Volume Superior Trunk and Superficial Cervical Plexus Block With Sedation as the Sole Regional Anesthetic for Proximal Humerus Fracture Fixation in a Patient With Alzheimer Disease.
Niruji Saengsomsuan, Lalida Sangkakit
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Case in brief
A 68-year-old woman with Alzheimer disease underwent fixation of a closed right proximal humerus fracture through a deltopectoral approach. To avoid general anesthesia, she received a low-volume superior trunk block (5 mL of 0.5% bupivacaine) and superficial cervical plexus block (3 mL of 0.5% bupivacaine), with propofol and dexmedetomidine sedation. The 174-minute operation was completed without rescue analgesia or conversion to general anesthesia; spontaneous ventilation and oxygen saturation were maintained. Analgesia lasted about 12 hours, and no clinically evident respiratory compromise or postoperative delirium was reported. She was discharged on postoperative day 2; diaphragmatic and cognitive function were not formally assessed.
What made this case unusual
The report describes proximal humerus fixation using low-volume superior trunk and superficial cervical plexus blocks as the sole regional anesthetic, with sedation, in a patient with Alzheimer disease. The case was completed without general anesthesia, but respiratory and cognitive outcomes were not formally measured.
Diagnostic / clinical pearl
A low-volume superior trunk block combined with superficial cervical plexus block may provide surgical anesthesia for proximal humerus fixation with sedation in an individual patient; clinically uneventful breathing does not establish preserved diaphragmatic function.