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Abstract
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Background and Aims Shoulder surgeries by arthroscopy or open methods have increased in recently. Regional Anesthesia is an excellent supplement to GA as well as can be used as the sole anesthetic technic in high-risk patients.
Methods We present the case of an 81-year-old female, known case of CAD, HTN, DM and Rheumatoid arthritis who was posted for shoulder debridement. She had a hospital re-admission after 2 days of hospital stay for 2 weeks due to septic shock (left shoulder infected wound) and AKI on CKD, requiring dialysis. She was re-admitted to MICU as she developed shortness of breath and generalized edema. CXR showed congestion and bilateral pleural effusion. PE was ruled out by CT. She was hypotensive requiring noradrenaline infusion. The diagnosis was Left shoulder draining sinus (septic arthritis) and she was posted for debridement. Owing to multiple comorbidities, it was decided to carry out the procedure under regional anesthesia. She was shifted to OR with Noradrenalne infusion which was continued intraoperatively. She received a left Interscalene block (15ml 0.5% Levobupivacaine), superficial cervical plexus block (5ml 0.33% Levobupivacaine) & Supraclavicular block (5ml 0.33% Levobupivacaine). She underwent Debridement and wash of Left shoulder and sinus excision.
Results She tolerated the procedure, without any sedation. Her clinical condition dramatically improved following the surgery, and she was weaned-off Noradrenaline the next day. She was transferred to the medical floor on the second post-operative day.
Conclusions Peripheral Nerve Blocks can be used as sole anesthetic technics for shoulder surgeries in high-risk patients in whom general anesthesia can be challenging.
Intraoperative Image of the Shoulder Surgery