Giant tumor resection under ultrasound-guided nerve block in a patient with severe asthma: A case report

Background: General anesthesia in critically ill patients is associated with increased risk of complications. Nerve block anesthesia is an alternative, but could be challenging in cases with surgical field that involves multiple dermatomes.

Case summary: We report resection of a giant lipoma in the left shoulder and upper back under supraclavicular brachial plexus block plus T3-4 paravertebral block in an older patient with severe asthma. A 70-year-old patient presented with a slow-growing giant mass (25, 15 and 5 cm in length, width and depth, respectively) that extended from the lateral side of the left scapula to the axillary midline, and from the T5 thoracic vertebra intercostal to the mid-medial section of the left upper arm. He had sharp intermittent pain over the mass for the past 7 d. The patient also had severe bronchial asthma for the past 8 years. A pulmonary function test revealed only 20% of the predicted forced expiratory volume in 1 second (FEV1, 0.49 L). After controlling asthma with glucocorticoid, the tumor was resected under ultrasound-guided supraclavicular brachial plexus block and T3-4 paravertebral block. The surgery was completed without incident.

Conclusion: Ultrasound-guided regional nerve block is a viable alternative for patients with poor cardiopulmonary function undergoing shoulder, back and axillary surgery.