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Application for ESRA Abstract Prizes : I apply as an Anesthesiologist (Aged 35 years old or less)Background and Aims We present a case of a 73-year-old gentleman with a displaced scapular spine fracture originating from the superior screw of a reverse total shoulder arthroplasty performed three months earlier. To help with perioperative pain, we used a dual regional anesthesia technique consisting of a thoracic paravertebral block and an anterior suprascapular nerve block to optimize analgesia. Before performing the paravertebral block, we used a small, curvilinear ultrasound probe identified the T2 and T3 spinous and transverse processes. A 22Gx8 cm Tuohy needle was inserted, aiming to contact the transverse process. After doing so, the needle was withdrawn to the subcutaneous tissue, redirected more caudad, and advanced 1 cm beyond the depth of the transverse process to enter the paravertebral space. 6 mL of 0.5% ropivacaine was deposited at each level (T2/T3 and T3/T4). The suprascapular nerve block was performed using a linear ultrasound probe (5–14 MHz). From the supraclavicular nerve block anatomy, the suprascapular nerve was identified as the most lateral branch of the upper trunk, exiting laterally and posteriorly under the omohyoid muscle to enter the shoulder joint. Under ultrasound guidance and nerve stimulation, a 22Gx5 cm insulated needle was inserted in-plane, from lateral to medial, and 10 mL of 0.5% ropivacaine was deposited near the suprascapular nerve, avoiding adjacent vessels. The blocks provided immediate pain relief, with the patient’s pain score decreasing from 8/10 to 2/10—this improved range of motion in his shoulder without causing total motor weakness. The case proceeded under general anesthesia, requiring no additional narcotics intraoperatively or postoperatively.Conclusions The paravertebral block offers segmental coverage of thoracic spinal nerves, addressing somatic and sympathetic pain pathways. The suprascapular nerve block targets the supraspinatus and infraspinatus muscles and a significant portion of the scapular periosteum without causing significant motor weakness. This multimodal approach ensured adequate intraoperative anesthesia and postoperative analgesia.