Ultrasound-guided interscalene block for shoulder avascular necrosis pain in the emergency department: A case report

Avascular necrosis (AVN) of the humeral head may cause severe pain requiring ED management, particularly in patients awaiting surgical treatment. A 38-year-old woman presented with severe left shoulder AVN pain refractory to oral and intravenous opioids. She received an ultrasound-guided interscalene brachial plexus block (ISB) with complete relief. She was discharged without the need for any subsequent analgesics in the ED. This case highlights the novel use of an emergency physician-performed ISB for AVN-related shoulder pain and supports the potential role of ultrasound-guided regional anesthesia as an opioid-sparing intervention for AVN-related pain in the ED.