Careskey Matthew, Naidu Ramana
From the Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California.
A A Case Rep. 2016 Jul 15;7(2):37-40. doi: 10.1213/XAA.0000000000000338.
Reverse open shoulder arthroplasty requires a comprehensive analgesic plan involving regional anesthesia. The commonly performed interscalene brachial plexus blockade confers a high likelihood of diaphragmatic paralysis via phrenic nerve palsy, making this option riskier in patients with limited pulmonary reserve. Continuous blockade of the suprascapular nerve, a more distal branch of the C5 and C6 nerve roots, may be a viable alternative. We report a successful case of the use of a suprascapular nerve block with continuous programmed intermittent bolus perineural analgesia in a patient with severe chronic obstructive pulmonary disease who underwent reverse open shoulder arthroplasty.
反式开放性肩关节置换术需要一个包括区域麻醉的全面镇痛方案。常用的肌间沟臂丛神经阻滞因膈神经麻痹而导致膈肌麻痹的可能性很高,这使得该方法在肺储备有限的患者中风险更高。肩胛上神经是C5和C6神经根的一个更远端分支,持续阻滞肩胛上神经可能是一种可行的替代方法。我们报告了一例严重慢性阻塞性肺疾病患者,在接受反式开放性肩关节置换术时,成功使用肩胛上神经阻滞并进行连续程序性间歇性推注神经周围镇痛的病例。