Anesthetic management of scapular Y-osteotomy using a combination of suprascapular nerve block and erector spinae plane block for Sprengel deformity associated with Klippel-Feil syndrome: a case report

Abstract

Background: Klippel-Feil syndrome (KFS) occurs in 1/40,000 individuals and is characterized by cervical fusion. Thirty percent of patients with KFS present with Sprengel deformity, leading to orthopedic problems and limited shoulder abduction. No reports exist regarding anesthetic procedures for pediatric scapular osteotomies.

Case presentation: We report a case of a 4-year-and-7-month-old boy (95.6 cm, 14.7 kg) who underwent left scapular osteotomy. At the age of 8 months, he also underwent a right lower lobectomy due to a congenital pulmonary airway malformation. We decided to use a combination of suprascapular nerve block (SSNB), erector spinae plane block (ESPB), and general anesthesia. He received regular acetaminophen administration and fentanyl 5-10 μg/hour intravenously until 20 h postoperatively and remained on ≤ 2/10 in the Wong-Baker Face Scale (0: no hurt; 10: hurts worst).

Conclusion: The combination of SSNB and ESPB could be an option for perioperative analgesia for scapular osteotomies.

Keywords: Erector spinae plane block; Pediatric anesthesia; Peripheral nerve block; Suprascapular nerve block.

Fig. 1

Surgical schematic of scapular Y-osteotomy proposed by Saisu (handwritten by himself). A Solid lines indicate the lines of osteotomies. Shaded lines indicate the areas to be resected. The lateral part of the scapula was pulled down while simultaneously improving downward rotation. The black arrow indicates the direction of the pull-down of the scapula. B After pulling down and suturing the lateral fragment of the scapula. The fascia of the infraspinatus was repaired, and the latissimus dorsi was sutured onto the infraspinatus after this process. DS, dorsal scapular nerve; IS, infraspinatus; LD, latissimus dorsi; LS, levator scapulae; RM, rhomboid major; SC, scapula; SP, spinous process; TR, trapezius

Fig. 2

Line of skin incision in this case (red line)

Fig. 3

Ultrasound image of peripheral nerve block. A Ultrasound image of suprascapular nerve block. The needle (white arrowhead) is moved toward the suprascapular nerve (white arrow). B Ultrasound image of the erector spinae plane block. The needle (white arrowhead) is inserted from the caudad to the cephalad to avoid damaging the surgical site. ESM, erector spinae muscle; LA, local anesthetic; TP, transverse process