Selective Upper-Trunk and Axillary Nerve Block for Awake Shoulder Arthroscopy in a Pulmonary Compromised Patient: A Case Report

A 48-year-old man with a superior labral tear and medical history including hemidiaphragmatic paresis, obstructive sleep apnea, vocal cord paresis, and glottic narrowing, underwent arthroscopic biceps tenodesis. Reduction in respiratory function presented anesthetic management challenges with general anesthesia or an interscalene brachial plexus block. Instead, ultrasound guidance was used to deliver a selective upper-trunk block with 1 % lidocaine and an axillary nerve block with 0.5 % ropivacaine. Immediately before incision, the surgeon administered 1 % lidocaine for LIA at the arthroscopic portal sites and within the shoulder capsule. The procedure was completed successfully with the patient awake and comfortable.