Intermediate cervical plexus block as an adjunct to neuraxial anesthesia: A novel approach to shoulder pain management during laparoscopic cholecystectomy in amyotrophic lateral sclerosis – A case report

Laparoscopic cholecystectomy is typically performed under general anesthesia (GA). However, neuraxial anesthesia (NA) is a viable alternative, especially in high-risk patients. A key limitation of NA is referred shoulder pain. This case report describes a 74-year-old male with amyotrophic lateral sclerosis who underwent laparoscopic cholecystectomy under NA with an intermediate cervical plexus block (ICPB) to prevent shoulder pain. Spinal anesthesia (T9-T10) combined with ultrasound-guided ICPB ensured effective analgesia without phrenic nerve blockade. The patient remained stable, had no intraoperative shoulder pain, and recovered uneventfully. ICPB may enhance applicability of NA in laparoscopic surgery, highlighting the need for further studies to standardize its application.