# Implementing Precision Regional Anesthesia in an Emergency Setting: Bilateral Upper Trunk Blocks for Shoulder Reduction

## TL;DR

A new regional anesthesia technique using upper trunk blocks successfully managed pain during shoulder reduction in a patient where general anesthesia was risky.

## Contribution

Bilateral upper trunk blocks are proposed as a safe, phrenic-sparing alternative to general anesthesia for bilateral shoulder dislocations.

## Key findings

- Bilateral upper trunk blocks provided complete analgesia without sedation or opioids.
- The patient was discharged safely with no adverse effects observed.
- The technique preserved airway reflexes and motor function.

## Abstract

Bilateral anterior shoulder dislocations (BASDs) are rare orthopedic emergencies that pose significant anesthetic challenges, particularly when standard sedation or general anesthesia (GA) is contraindicated due to non-fasted status or airway risk. A young, healthy male presented to the emergency department with radiologically confirmed bilateral anterior glenohumeral dislocations following a fall. He reported severe bilateral shoulder pain (visual analogue scale (VAS) 7/10 at rest, 10/10 on movement) but was cooperative, hemodynamically stable, and nil per os (NPO). Given the risk of aspiration, regional anesthesia (RA) was selected. Ultrasound-guided bilateral upper trunk blocks (UTBs) were administered using 3 mL of 2% lidocaine per side, without sedation, opioids, or premedication. Complete analgesia was achieved within minutes, preserving motor function and airway reflexes. Pain-free bilateral shoulder reductions were performed successfully. The patient was discharged 10 minutes post-procedure following two hours of observation. No adverse effects, including phrenic nerve palsy, were observed. While interscalene blocks remain the standard for shoulder analgesia, they are contraindicated bilaterally due to the near-universal risk of diaphragmatic paralysis. UTB, targeting the C5-C6 roots, provides selective analgesia to the suprascapular and axillary nerves with minimal risk to the phrenic nerve. This case illustrates the safety, efficacy, and practicality of bilateral UTB as a phrenic-sparing, opioid-free alternative in select BASD cases. In appropriately selected patients, bilateral UTB may offer a safe, airway-conscious alternative to GA or sedation for shoulder reduction, particularly in non-NPO or resource-constrained environments. This technique warrants further validation as a frontline option in emergency RA practice.