Perioperative Management of Interscalene Block in Patients with Lung Disease. (28th November 2013)

• Record Type: Journal Article
• Authors: Schwenk, Eric S.; Gandhi, Kishor; Viscusi, Eugene R.
• Other Names: Gomez R. S. Academic Editor.; Jakobsson J. G. Academic Editor.
• Is Part Of: Case reports in anesthesiology. Volume 2013(2013)
• Publication Date: 2013-11-28
• Subjects: Anesthesiology -- Periodicals; 617.9605
• DOI: 10.1155/2013/986386
• Languages: English
• ISSNs: 2090-6382

Abstract

Abstract : Interscalene nerve block impairs ipsilateral lung function and is relatively contraindicated for patients with lung impairment. We present a case of an 89-year-old female smoker with prior left lung lower lobectomy and mild to moderate lung disease who presented for right shoulder arthroplasty and insisted on regional anesthesia. The patient received a multimodal perioperative regimen that consisted of a continuous interscalene block, acetaminophen, ketorolac, and opioids. Surgery proceeded uneventfully and postoperative analgesia was excellent. Pulmonary physiology and management of these patients will be discussed. A risk/benefit discussion should occur with patients having impaired lung function before performance of interscalene blocks. In this particular patient with mild to moderate disease, analgesia was well managed through a multimodal approach including a continuous interscalene block, and close monitoring of respiratory status took place throughout the perioperative period, leading to a successful outcome.