Ultrasound-guided infraspinatus-teres minor plane block for acute post traumatic shoulder pain in the emergency department: A case series.

Acute traumatic shoulder injuries are often associated with severe pain that hinders examination, radiographic positioning, and timely orthopaedic management. Conventional systemic analgesia may be inadequate, while interscalene and superior trunk blocks can be limited by hemidiaphragmatic paresis. The ultrasound-guided infraspinatus teres minor (ITM) inter-fascial plane block is a recently described diaphragm-sparing technique that targets the suprascapular and axillary nerves through a single posterior injection and has shown promising anatomic and postoperative analgesic coverage in earlier reports. In this case series, four patients presenting to the emergency department with acute traumatic shoulder pain refractory to multimodal systemic analgesia, received ultrasound-guided ITM block using 20-25 mL of 0.375% ropivacaine with dexamethasone; three of them also received a continuous catheter infusion of 0.2% ropivacaine. Injuries included displaced proximal humeral fracture, glenoid fracture, humeral neck fracture, and humeral head dislocation. In all cases, pain scores fell rapidly from 8 to 10/10 to 0-1/10 within 30 min, facilitating examination, imaging, plaster application, immobilization, or closed reduction without rescue analgesia or procedural sedation. Analgesia remained satisfactory during observation, and no block-related complications were reported. These preliminary findings suggest that the ITM block may be an effective and practical diaphragm-sparing option for emergency department analgesia in acute shoulder injuries, with the added advantage of catheter-based prolongation when needed. Larger prospective comparative studies are required to confirm its efficacy, define safety, and clarify its role relative to other regional techniques.