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Review
. 2023 May 16;12(10):3483.
doi: 10.3390/jcm12103483.

Regional Anesthesia Techniques for Shoulder Surgery in High-Risk Pulmonary Patients

Bradley H Lee  1   2 , William P Qiao  1   2 , Stephen McCracken  1   2 , Michael N Singleton  1   2 , Mikhail Goman  1   2
Affiliations
Review

Regional Anesthesia Techniques for Shoulder Surgery in High-Risk Pulmonary Patients

Bradley H Lee et al. J Clin Med. .

Abstract

Patients with pre-existing pulmonary conditions are at risk for experiencing perioperative complications and increased morbidity. General anesthesia has historically been used for shoulder surgery, though regional anesthesia techniques are increasingly used to provide anesthesia and improved pain control after surgery. Relative to regional anesthesia, patients who undergo general anesthesia may be more prone to risks of barotrauma, postoperative hypoxemia, and pneumonia. High-risk pulmonary patients, in particular, may be exposed to these risks of general anesthesia. Traditional regional anesthesia techniques for shoulder surgery are associated with high rates of phrenic nerve paralysis which significantly impairs pulmonary function. Newer regional anesthesia techniques have been developed, however, that provide effective analgesia and surgical anesthesia while having much lower rates of phrenic nerve paralysis, thereby preserving pulmonary function.

Keywords: COPD; brachial plexus block; diaphragm-sparing; phrenic nerve sparing; shoulder surgery.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Diagram of brachial plexus. n. = nerve; C5 = Cervical nerve root 5; C6 = Cervical nerve root 6; C7 = Cervical nerve root 7; C8 = Cervical nerve root 8; T1 = Thoracic nerve root 1.
Figure 2
Figure 2
Interscalene and superior trunk blocks. SCM = Sternocleidomastoid muscle, ASM = Anterior scalene muscle, MSM = Middle scalene muscle, ST = Superior trunk. Yellow circle = Superior trunk; White line = Needle path for performing nerve block.
See this image and copyright information in PMC

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