Abstract
We report a case of fenestration surgery in a patient with concomitant low pulmonary function and dilated cardiomyopathy who was managed with epidural anesthesia and interscalene brachial plexus block.
The patient successfully underwent fenestration surgery for empyema with epidural anesthesia and interscalene brachial plexus block without general anesthesia. Generally, pain radiating toward the shoulders along the phrenic nerve as an afferent pathway is experienced when thoracotomy is performed under epidural anesthesia alone, whereas in this case, we were able to prevent such pain by the concomitant use of interscalene brachial plexus block and epidural anesthesia. Thus, control by local anesthesia was possible. We feel that this method may prove useful in cases where low cardiac function and low respiratory function coexist, as in this case.
