Maurya Indubala, Garg Rakesh, Jain Vijay Kumar, Iyengar Karthikeyan P, Vaishya Raju
Department of Anaesthesiology, Super Speciality Cancer Institute & Hospital, C.G. City, Sultanpur Road, Lucknow, Uttar Pradesh, India.
Additional Professor of Anaesthesiology, Critical Care and Pain, Department of Onco-Anaesthesiology and Palliative Medicine, Dr BRAIRCH, All India Institute of Medical Sciences, New Delhi, 110029, India.
J Clin Orthop Trauma. 2021 Feb 11;17:65-71. doi: 10.1016/j.jcot.2021.02.001. eCollection 2021 Jun.
Surgeries for Rotator Cuff (RC) pathologies are required for either trauma or degenerative related aetiologies. Various surgical techniques from open to arthroscopic repair, are being undertaken by orthopaedic surgeons. Peri-operative anaesthetic management of the patients undergoing rotator cuff repair requires understanding the surgical procedure and patient status for optimal anaesthetic planning. Such management mandates a thorough pre-operative evaluation, including clinical history, examination, and relevant investigations. Patients with acute trauma associated Rotator Cuff (RC) tears should be assessed for visceral injuries using appropriate injury evaluation systems before such repairs. On the other hand, patients with degenerative tears tend to be older with associated comorbidities. Hence pre-operative optimisation is necessary according to risk stratification. Anaesthetic techniques for Rotator Cuff (RC) surgery include general anaesthesia or regional anaesthesia. These are individualised according to patient assessment and surgical procedure planned. Knowledge of relevant surgical anatomy is essential for intra-operative, and post-operative neural blockade techniques since optimal peri-operative analgesia improve overall patient recovery. The occurrence of a peri-operative complication should be recognised as timely management improves the patient-related surgical outcomes. We describe the relevance of surgical anatomy, the effect of patient positioning, irrigating fluids, various anaesthetic techniques and an overview of regional and medical interventions to manage pain in patients undergoing for Rotator Cuff (RC) surgery.
肩袖（RC）病变的手术治疗适用于创伤或退行性相关病因。骨科医生正在采用从开放修复到关节镜修复的各种手术技术。肩袖修复手术患者的围手术期麻醉管理需要了解手术过程和患者状况，以进行最佳的麻醉规划。这种管理要求进行全面的术前评估，包括临床病史、检查和相关检查。对于急性创伤性肩袖（RC）撕裂患者，在此类修复之前应使用适当的损伤评估系统评估内脏损伤。另一方面，退行性撕裂患者往往年龄较大且伴有合并症。因此，需要根据风险分层进行术前优化。肩袖（RC）手术的麻醉技术包括全身麻醉或区域麻醉。这些技术根据患者评估和计划的手术程序进行个体化选择。了解相关手术解剖结构对于术中及术后神经阻滞技术至关重要，因为最佳的围手术期镇痛可改善患者的整体恢复情况。围手术期并发症的发生应得到及时识别，因为及时处理可改善与患者相关的手术结局。我们描述了手术解剖结构的相关性、患者体位的影响、冲洗液、各种麻醉技术以及用于管理肩袖（RC）手术患者疼痛的区域和药物干预概述。
