title: The use of cervical paravertebral block as the sole anesthetic for shoulder surgery in a morbid patient: a case report.
abstract: OBJECTIVE
  The purpose of this case report is to describe the use of the cervical paravertebral block as the sole anesthetic for shoulder surgery in a patient unable to tolerate general anesthesia. Recent literature describes the continuous cervical paravertebral block as an effective alternative to the interscalene block for the management of postoperative pain after shoulder surgery.
  
  
  METHODS
  An 85-year-old man with severe respiratory and cardiac disease presented for major shoulder surgery. The patient's complex medical history required an anesthetic technique that would avoid general anesthesia and preserve phrenic nerve function. This case report describes, to our knowledge, the first successful use of the continuous cervical paravertebral block as the sole anesthetic for shoulder surgery.
  
  
  CONCLUSIONS
  Continuous cervical paravertebral block provided excellent surgical conditions and postoperative pain relief for this patient and allowed gradual and intermittent dosing of the catheter and continuous assessment of the anesthetic impact on respiratory function.
authors.affiliation: Department of Anesthesiology, College of Nursing, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Koorn
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Tenhundfeld Fear
authors.forename: Chantelle
authors.initials: C
authors.lastname: Miller
authors.forename: André
authors.initials: A
authors.lastname: Boezaart
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000772:Anesthesia, Local / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage; D002574:Cervical Vertebrae / Q000187:drug effects / Q000502:physiology; D006801:Humans; D008297:Male; D009407:Nerve Block / Q000379:methods*; D009767:Obesity, Morbid / Q000188:drug therapy / Q000601:surgery*; D010149:Postoperative Pain / Q000188:drug therapy / Q000628:therapy*; D012785:Shoulder Joint / Q000187:drug effects / Q000601:surgery*
chemical_list: D000779:Anesthetics, Local