Arthroscopic shoulder surgery in the beach chair position under single interscalene block does not affect patients'...

Area of Science:

• Anesthesiology
• Neurosurgery
• Geriatric Medicine

Background:

• Postoperative delirium is linked to dementia development, making prevention crucial.
• The beach chair position (BCP) for shoulder surgery may increase delirium risk due to potential cerebral hypoperfusion.
• Regional anesthesia, specifically interscalene block (ISB), offers better hemodynamic stability in the BCP compared to general anesthesia.

Purpose of the Study:

• To determine if arthroscopic shoulder surgery in the BCP under ISB anesthesia affects the incidence of postoperative delirium.
• To evaluate the neurocognitive outcomes of patients undergoing shoulder surgery with ISB.

Main Methods:

• 863 patients undergoing arthroscopic shoulder surgery under ultrasound-guided single ISB were analyzed.
• Delirium was assessed using the Delirium Rating Scale-Revised-98 (DRS-R98) preoperatively and at multiple time points postoperatively.
• A DRS-R98 score of 10 or higher indicated delirium.

Main Results:

• No significant differences were observed in pre- and postoperative DRS-R98 scores.
• Only three patients (all over 80 with high preoperative scores) met delirium criteria at 7 days, with scores normalizing by 12 months.
• Cognitive function remained unaffected by ISB anesthesia during shoulder surgery.

Conclusions:

• Arthroscopic shoulder surgery performed with a single ISB does not appear to impact cognitive function.
• ISB represents a safe and effective alternative to general anesthesia for elderly patients undergoing shoulder surgery.
• ISB anesthesia may mitigate the risk of postoperative delirium associated with the beach chair position.