Block Combination for Shoulder Surgery in a Patient With a Free Flap on the Neck: The Serratus Posterior Superior Intercostal Plane Block Completes the Puzzle: A Case Report

In this case report, successful perioperative management was achieved using a combination of regional anesthesia techniques in a patient with a free flap on the neck and anticipated difficult intubation scheduled for open shoulder surgery. Supraclavicular brachial plexus (SCBPB), suprascapular nerve (SSB), axillary nerve (ANB), and serratus posterior superior intercostal plane block (SPSIPB) were performed. This case demonstrates that fascial plane blocks may be integrated into regional anesthesia strategies to enhance dermatomal coverage in shoulder surgeries with complex innervation. Adequate postoperative analgesia was achieved without any complications.