{
  "abstract": "Background and Aims Regional anesthesia is preferred alone or in combination with general anesthesia for shoulder surgery due to its advantages, including hemodynamic stability, effective postoperative analgesia and avoidance of airway manipulation. Our patient had a history of recurrent tracheotomy and free flap reconstruction of the right neck and cheek( figure 1), which significantly altered the anatomical structure, rendering interscalene block (ISB) unfeasible. Therefore, a combination of supraclavicular brachial plexus block (SCBPB), suprascapular nerve block (SSB), axillary nerve block (ANB) and serratus posterior superior intercostal plane block (SPSIPB) was selected.Methods CASE REPORT/Methods A 50-year-old male, scheduled for metastatic mass resection from the right acromion, had a history of malignant buccal mucosa tumors, mandibulectomy, extensive neck dissection, and free flap reconstruction. Previous surgeries required tracheotomies, which were later decannulated before discharge. A total of 200 mg of bupivacaine was used under ultrasound guidance: SCBPB, SSB, ANB , and SPSIPB ( table 1) (figure 2). Sedation was provided using dexmedetomidine. The 150-minute surgery proceeded without additional analgesics (figure 3). Postoperatively, the highest NRS pain score was 3, with no opioid need over 36 hours.Abstract P156 Table 1PICT data collection tool - lower limb blocksResults ISB was contraindicated due to anatomical disruption. SCBPB alone may not ensure complete anesthesia; thus, SSB and ANB were added. SPSIPB is a newly described block. Fascial plane blocks may be preferred to expand the dermatomal block area in regions with multiple dermatomal innervations. To provide anesthesia for the relevant surgical area, a thorough understanding of dermatomal, myotomal, and osteotomal innervations is required. This knowledge enables the creation of block combinations that effectively cover the targeted region.Abstract P159 Figure 1Preoperative physical examination of the patientAbstract P159 Figure 2Four regional anesthesia techniques; collective display of probe positions and ultrasound imagesAbstract P159 Figure 3Images of the surgical field and the patient with nasal airway placement",
  "authors": [
    {
      "affiliations": [
        "Ankara Etlik City Hospital, Ankara, Turkey"
      ],
      "name": "Erbin Kandemir"
    },
    {
      "affiliations": [
        "Ankara Etlik City Hospital, Ankara, Turkey"
      ],
      "name": "Can Ozan Yazar"
    },
    {
      "affiliations": [
        "Ankara Etlik City Hospital, Ankara, Turkey"
      ],
      "name": "Nur Ipek Senel"
    },
    {
      "affiliations": [
        "Ankara Etlik City Hospital, Ankara, Turkey"
      ],
      "name": "Huseyin Bilgehan Cevik"
    },
    {
      "affiliations": [
        "Ankara Etlik City Hospital, Ankara, Turkey"
      ],
      "name": "Derya Ozkan"
    }
  ],
  "title": "P159 Block combination for shoulder surgery in a patient with a free flap on the neck: the serratus posterior superior intercostal plane block completes the puzzle",
  "uid": "7ff30f89-7ad6-59d2-8a43-d023a870c4de"
}