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Published on: May 26, 2023
Regional Anesthesia With Noninvasive Ventilation for Shoulder Surgery in a Patient With Severe Chronic Obstructive
Fabrice Ferré1, Nina Cugnin, Charlotte Martin
1From the *Department of Anesthesiology and Critical Care Medicine, Purpan University Hospital, Toulouse, France; †Department of Anesthesia, Clinique Médipôle Garonne, Toulouse, France; ‡Department of Orthopedic Surgery, Purpan University Hospital, Toulouse, France; and §Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada.
Abstract:
Interscalene block (ISB) impairs ipsilateral lung function and generally is not used for patients with respiratory insufficiency. We present a 49-year-old man with chronic obstructive pulmonary disease scheduled for shoulder surgery. He was given a regional technique with an ISB (short-acting local anesthetic to minimize duration of diaphragmatic dysfunction) and suprascapular and axillary nerves blocks (long-acting local anesthetic). He was supported with noninvasive ventilation during the time of hemidiaphragmatic paralysis as documented by serial ultrasound examination. A discussion about ISB and its alternatives (general anesthesia versus brachial plexus block versus selective peripheral nerve blocks) always should occur for patients at risk for pulmonary complications.
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