BACKGROUND & AIMS: 

General anaesthesia in patients with severe respiratory disease is associated with increased morbidity and mortality. Awake surgery under interscalene block may be considered. However, the incidence of phrenic nerve palsy with subsequent reduction in FEV1 and FVC may be prohibitive.

METHODS: 
We present the case report of a 60-year-old gentleman with severe COPD who successfully underwent complex shoulder hemiarthroplasty under interscalene plus supraclavicular nerve blockade. On preoperative assessment the patient gave a history of ongoing smoking with limited exercise tolerance and shortness of breath at rest. Radiological imaging revealed bullous emphysema and spirometry demonstrated significant obstructive disease.

RESULTS: 
Interscalene and supraclavicular nerve blocks were performed under conscious sedation using an in-plane ultrasound technique. A volume of 15ml of 2% lidocaine + 0.5% levobupivacaine was infiltrated within the brachial plexus sheath and a further 5ml 0.5% levobupivacaine at the supraclavicular nerve. There were no immediate complications, surgery was successfully performed with good regional anaesthesia and no oxygen desaturation or breathlessness.  The patient was discharged without any complications.

CONCLUSIONS: 
This case demonstrates that advances in regional anaesthesia have made it possible to operate on medically challenging cases, where general anaesthesia is associated with increased morbidity and mortality. Further studies are required to investigate the role supraclavicular nerve plays in breakthrough pain during awake shoulder surgery and the use of supraclavicular nerve blockade to facilitate lower volume interscalene block.

AWAKE SHOULDER HEMIARTHROPLASTY WITH ULTRASOUND-GUIDED INTERSCALENE AND SUPRACLAVICULAR NERVE BLOCKADE IN PATIENT WITH SEVERE COPD: A CASE REPORT