Clinical care pathways for ambulatory total shoulder arthroplasty

Area of Science:

• Anesthesiology
• Orthopedic Surgery
• Pain Management

Background:

• Total shoulder arthroplasty (TSA) is increasingly performed on an outpatient basis.
• Optimizing anesthesia and analgesia is crucial for ambulatory shoulder surgery success.

Purpose of the Study:

• To review recent advancements in anesthesia and analgesia for ambulatory shoulder surgery.
• To discuss components of an effective surgical pathway and provide a sample pathway.

Main Methods:

• Literature review of current anesthesia and analgesia techniques for ambulatory TSA.
• Analysis of pathway components, including patient selection, education, nerve blockade, and multimodal analgesia.

Main Results:

• Pathway adoption enhances patient experience by decreasing pain, opioid consumption, and side effects.
• Long-acting peripheral nerve blocks (e.g., interscalene, supraclavicular) with adjuvants like dexamethasone offer superior analgesia.
• Multimodal analgesia should incorporate acetaminophen and NSAIDs, but routine gabapentinoids are not recommended.

Conclusions:

• Anesthesiologists should spearhead the development and implementation of ambulatory TSA pathways.
• Key elements include careful patient selection, thorough education, effective nerve blockade, and multimodal pain management strategies.