Regional Techniques for
Open Scapulothoracic Fusion
in Facioscapulohumeral
Muscular Dystrophy

Introduction: A 57 y.o. male with facioscapulohumeral muscular dystrophy was scheduled
to undergo open scapulothoracic fusion with iliac crest autograft and multiple intercostal fusions
(T2/3, T3/4, T4/5, T5/6, T6/7, and T7/8).
Regional anesthesia considerations: Muscular dystrophy (sensitivity to opioids,
optimization of respiratory function perioperatively); prone (posterior approach); broad surgical site
involving midline; scapulothoracic surgery with multiple thoracic levels involved
Anesthetic management:
Preoperative ultrasound-guided:
- Right-sided T3 erector spinae plane block (20mL of 0.5% ropivacaine)
- Superior trunks block (10mL of 0.5% ropivacaine)
- Superficial cervical plexus block (5mL of 0.5% ropivacaine)
Intraoperative analgesia:
- Ketorolac 30mg IV
- Ketamine 20mg IV
- Hydromorphone 0.8mg IV
- Dexamethasone 8mg IV
Postoperative analgesia:
- Hydromorphone 2mg PO q4h prn
- Minimal back discomfort (2/10)
- Regional analgesia lasted for 10 hours
Total intraoperative time was 4 hours. No pain crisis, respiratory depression, prolonged weakness,
nausea or vomiting, or neurologic deficit occurred. He was discharged home on POD 1
uneventfully.