Abstract
Introduction:The patient with an unstable shoulder represents a challenge for the anesthesiologist. Most patients will be young individuals in good health but both shoulder dislocation reduction, a procedure that is usually performed under specific analgesia in an urgent setting, and instability surgery anesthesia and postoperative management present certain peculiarities.Material and Methods:For the purpose of the article, 78 references including clinical trials and reviews were included. The review was organized considering the patient that presents an acute shoulder dislocation and the patient with chronic shoulder instability that requires surgery. In both cases the aspects like general or regional anesthesia, surgical positions and postoperative pain management were analyzed.Conclusion:The patient with an acutely dislocated shoulder is usually managed in the emergency room. Although reduction without analgesia is often performed in non-medical settings, an appropriate level of analgesia will ease the reduction procedure avoiding further complications. Intravenous analgesia and sedation is considered the gold standard but requires appropriate monitorization and airway control. Intraarticular local analgesic injection is considered also a safe and effective procedure. General anesthesia or nerve blocks can also be considered. The surgical management of the patient with shoulder instability requires a proper anesthetic management. This should start with an exhaustive preoperative evaluation that should be focused in identifying potential respiratory problems that might be complicated by local nerve blocks. Intraoperative management can be challenging, especially for patients operated in beach chair position, for the relationship with problems related to cerebral hypoperfusion, a situation related to hypotension events directly linked to patient positioning. Different nerve blocks will help attaining excellent analgesia both during and after the surgical procedure. An interescalene nerve block should be considered the best technique, but in certain cases, other blocks can be considered.
Highlights
The patient with an unstable shoulder represents a challenge for the anesthesiologist
There are two basic positions in which shoulder surgery is performed for instability problems: lateral decubitus position (LDP) or beach chair position (BCP) [29]
The results showed that the measured pressure in the leg is higher than that measured in the arm before induction of anesthesia, during induction, before intubation and during beach chair position [34], they concluded that noninvasive blood pressure must be measured in the non-operated arm
Summary
Anesthetic techniques in shoulder surgery have evolved along with surgery. The performance of increasingly complex but less invasive techniques in the unstable shoulder has required the development of anesthetic techniques that allow an adequate control pain during the intraoperative and postoperative period. The Open Orthopaedics Journal, 2017, Volume 11 849 requires surgery the priority is to provide conditions that lead a safe articular fix and regional anesthesia (RA) can be considered a complement of anesthetic management. In this respect, all nerve blockades of the brachial plexus (BP) used in the shoulder surgery, like the Interescalene nerve block (ISNB), supraclavicular nerve block (SCNB), suprascapular nerve block (SSNB), will be considered in this review. The patient with a dislocated shoulder probably epitomizes the acute trauma case: a usually young patient with severe pain and disability that requires prompt management. Anyway when the patient is evaluated in a medical setting an analgesia technique should be offered to most patients
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