Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 6, 2022; 10(10): 3200-3205
Published online Apr 6, 2022. doi: 10.12998/wjcc.v10.i10.3200
Giant tumor resection under ultrasound-guided nerve block in a patient with severe asthma: A case report
Qian Liu, Qing Zhong, Ni-Na Zhou, Ling Ye
Qian Liu, Ling Ye, Department of Pain Management, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Qing Zhong, Department of Anesthesiology, The People's Hospital of Jianyang City, Jianyang 610041, Sichuan Province, China
Ni-Na Zhou, Department of Anesthesiology, Zigong First People’s Hospital, Zigong 643000, Sichuan Province, China
Author contributions: Liu Q, Zhong Q and Zhou NN contributed equally to the work; all authors contributed to data analysis, drafting or revising the manuscript, approved the final version to be published, and agreed to be accountable for all aspects of the work.
Informed consent statement: Informed written consent was obtained from the patients for the publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ling Ye, MD, Doctor, Department of Pain Management, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu 610041, Sichuan Province, China. zerodq_hx@163.com
Received: November 6, 2021
Peer-review started: November 6, 2021
First decision: December 27, 2021
Revised: January 5, 2022
Accepted: February 23, 2022
Article in press: February 23, 2022
Published online: April 6, 2022
Processing time: 143 Days and 10.2 Hours
Abstract
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.

Keywords: Ultrasound; Giant tumor; Brachial plexus block; Paravertebral block; Case report

Core Tip: A giant lipoma that extended from the lateral side of the left scapula to the axillary midline, and from the fifth thoracic vertebra intercostal to the mid-medial section of the left upper arm was resected under ultrasound-guided brachial plexus block combined with thoracic paravertebral nerve block in an older patient with severe asthma. The patient recovered well after the operation. This anesthetic method could be a viable alternative to general anesthesia and epidural anesthesia in patients with poor cardiopulmonary function undergoing shoulder, back and axillary surgery.