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Shoulder block in severe COPD — FRCA Final MCQ

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HardRegional AnaesthesiaShoulder block in severe COPDFRCA Final

A 63-year-old man with severe chronic obstructive pulmonary disease is scheduled for shoulder arthroplasty. He has an FEV1 of 32% predicted and becomes breathless walking across the ward. The surgeon requests regional analgesia, but diaphragmatic function is clinically important. What is the most appropriate anaesthetic technique?

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Correct answer: B — Suprascapular and axillary nerve blocks with general anaesthesia

A conventional interscalene block commonly causes ipsilateral phrenic nerve palsy, which may be poorly tolerated in severe COPD. Combined suprascapular and axillary nerve blocks can provide shoulder analgesia with less diaphragmatic impairment. Infraclavicular block does not reliably cover shoulder joint innervation. The anaesthetic plan should balance analgesia against respiratory reserve.

Reference: RA-UK/ESRA regional anaesthesia guidance; RCoA Final FRCA Syllabus 2026