Anaes Cases · Ultrasound-guided peripheral nerve blocks
Regional anaesthesia for a shoulder replacement
The interscalene-vs-COPD long case — the phrenic nerve block (almost 100 per cent with the interscalene) is contraindicated in the severe respiratory disease. The alternatives: the supraclavicular (less phrenic), the superior trunk block, or the GA with the opioid-sparing multimodal analgesia.
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Prompt
A 68-year-old man with severe COPD (FEV1 40 per cent) needs a total shoulder replacement. The surgeon suggests an interscalene block. Discuss the suitability and the alternatives.
Presentation
A 68-year-old man with a severe chronic obstructive pulmonary disease (FEV1 40 per cent predicted, on home oxygen) is scheduled for a total shoulder replacement. The surgeon suggests an interscalene block for the postoperative analgesia. Discuss the suitability and the alternatives.
References2ShowHide
- [2]Wang ZX, et al. Efficacy of ultrasound and nerve stimulation guidance in peripheral nerve block: A systematic review and meta-analysis. IUBMB Life, 2017.PMID 28714206
- [28714207]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.