Background and aims
Most surgical procedures on patients suffering from polytraumatic injuries are performed under general anesthesia: patients with multiple bone fractures and internal organ injuries are at high risk for developing subsequent systemic disorders. Here we show a case of an American Society of Anesthesiologists classification (ASA) III patient, scheduled for reposition and osteosynthesis of the humerus. Due to a high risk for general anesthesia, we decided to apply interscalene block with intravenous sedation.
Methods
A 41-year-old female, ASA III patient, was scheduled for reposition and osteosynthesis of her right humerus. During her fall, the patient sustained polytrauma injuries: right sided pneumothorax with bilateral lung contusions, body fractures of the cervical (C)5 and C6 vertebrae, fractures of the  thoracic (Th)4,Th5,Th8, Th11 and lumbal (L)1, L2 and L3 vertebrae with previously performed stabilization and spongioplasty. During preparation for surgery, an invasive blood pressure measurement was set up while the interscalene space was identified using a nerve-stimulating needle and a linear ultrasound probe of 12 Hertz. An anesthetic solution of 0.5% levobupivacaine was applied to the brachial plexus (20 milliliters). We used 1% lidocaine for skin infiltration and sedation was performed with a continuous infusion of 1% propofol.
Results
Sensory blockade occurred after 10 minutes and lasted for about 18 hours. The procedure was carried out uneventfully without any complications.
Conclusion
The application of ultrasound and nerve stimulator in interscalene block, enabled us to achieve high precision. Such administration of long-acting local anesthetic  has resulted in a satisfactory anesthesia and analgesia without hemodynamic, respiratory or neurological complications.




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Disclossure: nothing to declare

THE APPLICATION OF A INTERSCALENE BLOCK IN A POLYTRAUMATIZED PATIENT WITH A HUMERUS FRACTURE AS ANESTHESIA CHOICE: A CASE REPORT