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Regional Anesthesia Procedures for Shoulder and Upper Arm Surgery Upper Extremity Update—2005 to Present
- Source :
- International Anesthesiology Clinics. 50:26-46
- Publication Year :
- 2012
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2012.
-
Abstract
- This review of the literature since 2005 assesses developments of RA techniques commonly used for shoulder surgery, and their effectiveness for postoperative analgesia. Advantages of regional techniques include site-specific anesthesia and decreased postoperative opioid use. For shoulder surgeries, the ISB provides effective analgesia with minimal complications, whereas the impacts of IA single-injections remain unclear. When combined with GA, ISB can be used in lower volumes and reducing the complications for shoulder and proximal upper extremity. USG ISB and SCB are both effective and safe for shoulder surgery with a low incidence of complications, especially PONS.53 When compared with intravenous patient-controlled opioid analgesia, a perineural LA infusion using a disposable pump with patient-controlled LA bolus function has led to better pain relief and functional recovery while decreasing the need for rescue analgesics and the number of adverse events after ambulatory orthopedic surgery. The most remarkable advance in RA in the past 5 years is the increased usage of USG. Although there are no large-scale prospective studies to show the safety, efficacy, and success and complication rates for USG blocks, USG RA theoretically could have less risk for neurologic symptoms, except for those induced by LA (less likely perineurally, much more likely intraneurally). The next "quantum leap" lies in reducing LA concentrations and augmenting anesthetic-analgesic effects with perineural additives (including clonidine, buprenorphine, and likely low-dose dexamethasone). Since 2005, perineural catheters have been an analgesic option that offers improved pain relief among other benefits, and are now being used at home. It is clear that patients benefit greatly from a single injection and continuous nerve block for postoperative pain management,but the financial and logistical aspects need to be resolved, not to mention the phrenic hemiparesis coin toss. Whether combined perineural analgesic adjuvants prolong low-concentration LA nerve blocks sufficiently to render brachial plexus catheters as unnecessary would certainly represent another quantum leap.
- Subjects :
- Shoulder
medicine.medical_specialty
Shoulder surgery
medicine.medical_treatment
Analgesic
Anesthesia, General
Anesthesia, Conduction
medicine
Animals
Humans
Anesthetics, Local
Pain, Postoperative
business.industry
Nerve Block
Anesthetics, Combined
Surgery
Anesthesiology and Pain Medicine
Hemiparesis
Orthopedic surgery
Ambulatory
Arm
Nerve block
medicine.symptom
business
Brachial plexus
Buprenorphine
medicine.drug
Subjects
Details
- ISSN :
- 00205907
- Volume :
- 50
- Database :
- OpenAIRE
- Journal :
- International Anesthesiology Clinics
- Accession number :
- edsair.doi.dedup.....7675e67741384386bc39d3a47ec02344