Abstract
There has been an exponential growth in the volume of shoulder surgery in the last 2 decades and a very wide variety of anaesthetic techniques have emerged to provide anaesthesia and post-operative analgesia. In this article we examine current opinion, risks, benefits and practicalities of anaesthetic practice and the provision of post-operative analgesia for shoulder surgery.
Highlights
There is considerable diversity in the manner in which anaesthetists approach the provision of shoulder surgery
Advances in minimally invasive techniques are extending the benefits of shoulder surgery to ever more frail patients with greater co-morbidity who would normally be regarded as very high risk for general anaesthesia
Some concerns have been raised regarding the the possibility of amide local anaesthetics (LA) induced chondrotoxicity manifesting as devastating post-arthroscopic glenohumeral chondrolysis (PAGCL) and there does seem to be in vitro evidence to this effect [25], more pronounced for lignocaine than bupivacaine [26]
Summary
There is considerable diversity in the manner in which anaesthetists approach the provision of shoulder surgery. No regional anaesthetic technique has a 100% success rate and even with a successful nerve block the risk of inadequate analgesia necessitating conversion to general anaesthesia persist, with conversion rates upto 8.7-13% in some series [10, 11]. Anaesthesia for Shoulder Surgery epinephrine, Kim et al found that perineural dexamethasone with SSISB provided lower pain scores with an effect extending up to 48 hours [34].
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