TY  - JOUR
T1  - Superior Trunk Block: A Novel Approach for Shoulder Reduction in Pregnancy
TT  - Superior Trunk Block: Gebelikte Omuz Redüksiyonu İçin Yenilikçi Bir Yaklaşım
AU  - Tan, Chun Chau
PY  - 2025
DA  - March
Y2  - 2025
DO  - 10.33706/jemcr.1598621
JF  - Journal of Emergency Medicine Case Reports
PB  - Acil Tıp Uzmanları Derneği
WT  - DergiPark
SN  - 2149-9934
SP  - 38
EP  - 41
VL  - 16
IS  - 1
LA  - en
AB  - Anterior shoulder dislocations are common in emergency settings but are rarely reported in pregnant patients, necessitating careful pain management to ensure maternal and fetal safety. While procedural sedation and analgesia are conventional approaches, they carry risks such as altered maternal consciousness, raising concerns during pregnancy. Ultrasound-guided regional anaesthesia offers a safer and more effective alternative, particularly nerve blocks. We present the case of a 30-year-old woman at 28 weeks of gestation with a recurrent anterior shoulder dislocation. An ultrasound-guided superior trunk block was performed, targeting the superior trunk of the brachial plexus, which is formed by the C5-C6 nerve roots, offering a promising alternative to the interscalene brachial plexus block for shoulder procedures in pregnant patients. This technique provided effective analgesia, facilitating successful closed manipulative reduction without maternal or fetal complications, thereby supporting its broader adoption in similar clinical context scenarios.
KW  - Shoulder Dislocation
KW  - Regional Anesthesia
KW  - Superior Trunk Block
N2  - Ön omuz çıkıkları, acil durumlarda yaygın olarak görülse de, hamile hastalarda nadiren bildirilmekte ve bu da anne ve fetus güvenliğini sağlamak için dikkatli bir ağrı yönetimini gerektirmektedir. Prosedürel sedasyon ve analjezi geleneksel yaklaşımlar olsa da, anne bilinç seviyesindeki değişiklikler gibi riskler taşıdığından, gebelik sırasında endişelere yol açmaktadır. Ultrason rehberliğinde yapılan bölgesel anestezi, özellikle sinir blokları, daha güvenli ve etkili bir alternatif sunmaktadır. 28 haftalık hamile, tekrar eden ön omuz çıkığı olan 30 yaşındaki bir kadın vakasını sunuyoruz. Ultrason rehberliğinde, C5-C6 sinir köklerinden oluşan brakiyal pleksusun üst dalını hedef alan bir üst dal bloğu yapıldı. Bu yöntem, hamile hastalarda omuz işlemleri için interskalene brakiyal pleksus bloğuna umut verici bir alternatif sunmaktadır. Bu teknik, etkili analjezi sağlayarak başarılı bir kapalı manipülatif redüksiyonu kolaylaştırdı ve anne ya da fetal komplikasyon olmadan gerçekleşti, bu da benzer klinik senaryolarda daha geniş bir şekilde kullanılmasını desteklemektedir.
CR  - 1. Gottlieb M. Shoulder dislocations in the emergency department: a comprehensive review of reduction techniques. The Journal of Emergency Medicine. 2020;58(4):647-66.
CR  - 2. Owens BD, Cameron KL, Clifton KB, Svoboda SJ, Wolf JM. Association between serum relaxin and subsequent shoulder instability. Orthopedics. 2016;39(4):e724-e8.
CR  - 3. Hayashi M, Kano K, Kuroda N, Yamamoto N, Shiroshita A, Kataoka Y. Comparative efficacy of sedation or analgesia methods for reduction of anterior shoulder dislocation: A systematic review and network meta‐analysis. Academic Emergency Medicine. 2022;29(10):1160-71.
CR  - 4. Neuman G, Koren G. Safety of procedural sedation in pregnancy. Journal of obstetrics and gynaecology Canada. 2013;35(2):168-73.
CR  - 5. Gawel RJ, Grill R, Bradley N, Luong J, Au AK. Ultrasound-guided peripheral nerve blocks for shoulder dislocation in the emergency department: a systemic review. The Journal of Emergency Medicine. 2023;65(5):e403-e13.
CR  - 6. Sithamparapillai A, Grewal K, Thompson C, Walsh C, McLeod S. Intra-articular lidocaine versus intravenous sedation for closed reduction of acute anterior shoulder dislocation in the emergency department: a systematic review and meta-analysis. Canadian Journal of Emergency Medicine. 2022;24(8):809-19.
CR  - 7. Kumaran SNS, MEmMed MLH, binti Jusoh SR. Development of ultrasound guided regional anaesthesia in the emergency department, Hospital Kuala Lumpur. Med J Malaysia. 2024;79(3):371.
CR  - 8. Yao L, Dong W, Wu Z, Zhao Q, Mao H. Ultrasound-guided interscalene block versus intravenous analgesia and sedation for reduction of first anterior shoulder dislocation. The American Journal of Emergency Medicine. 2022;56:232-5.
CR  - 9. Campbell AS, Johnson CD, O’Connor S. Impact of Peripheral Nerve Block Technique on Incidence of Phrenic Nerve Palsy in Shoulder Surgery. Anesthesiology Research and Practice. 2023;2023(1):9962595.
CR  - 10. Amaral S, Lombardi RA, Medeiros H, Nogueira A, Gadsden J. Superior Trunk Block Is an Effective Phrenic-Sparing Alternative to Interscalene Block for Shoulder Arthroscopy: A Systematic Review and Meta-Analysis. Cureus. 2023;15(11).
CR  - 11. Laurent DB-S, Chan V, Chin KJ. Refining the ultrasound-guided interscalene brachial plexus block: the superior trunk approach. Canadian Journal of Anesthesia. 2014;61(12):1098-102.
CR  - 12. Kim DH, Lin Y, Beathe JC, Liu J, Oxendine JA, Haskins SC, et al. Superior trunk block: a phrenic-sparing alternative to the interscalene block: a randomized controlled trial. Anesthesiology. 2019;131(3):521-33.
CR  - 13. Mohanty CR, Gupta A, Radhakrishnan RV, Singh N, Patra SK. Ultrasound-guided low-volume anterior suprascapular nerve block for reduction of anterior shoulder dislocation in the emergency department: A case series. Turkish journal of emergency medicine. 2023;23(4):254-7.
UR  - https://doi.org/10.33706/jemcr.1598621
L1  - https://dergipark.org.tr/tr/download/article-file/4427322
ER  -