[Cervical epidural anesthesia with 0.75% ropivacaine in shoulder surgery]

We present the cases of three patients scheduled for shoulder surgery under cervical epidural anesthesia with 0.75% ropivacaine. The technique was successful and surgery proceeded uneventfully in all three cases. The total doses of ropivacaine infused were 67, 90 and 109 mg. Premedication with intravenous atropine is recommended. Cervical epidural anesthesia offers several advantages over general anesthesia and other regional techniques for shoulder surgery: postoperative analgesia, lower total dose of the local anesthetic and single needle insertion with no need to elicit paresthesias or muscle movements. This technique brings about hemodynamic and respiratory changes in function of the extension and intensity of the block. Extent of the blockade to the upper thoracic sensory segments causes a total or partial sympathetic block with decreased heart rate, blood pressure and cardiac output. Limiting the initial and subsequent doses to restrict the sensory blockade to the surgical area will reduce hemodynamic complications. Ropivacaine provides an effective sensory block and a restricted motor block, reducing the probability of the restrictive pulmonary syndrome associated with cervical epidural anesthesia.