Anesthesia in Total Shoulder Arthroplasty

Abstract

» For shoulder arthroplasty, regional anesthesia is safer when compared with general anesthesia. There is insufficient evidence to demonstrate the superiority of regional anesthesia with respect to pulmonary complications and hospital length of stay.» Infiltration of the shoulder with local anesthetics offers no additional benefits compared with single-shot or continuous brachial plexus blocks for shoulder arthroplasty.» There is high-quality evidence (Level I) demonstrating lower pain scores and lower perioperative opioid requirements after a continuous peripheral nerve block compared with a single-shot nerve block. However, catheter dislodgment and logistical issues with catheter insertion are impediments to the widespread usage of a continuous nerve block with an indwelling catheter.» Liposomal bupivacaine is comparable with non-liposomal local anesthetic agents with respect to pain relief, the opioid-sparing effect, and adverse effects in the first 48 hours after total shoulder arthroplasty.» Perioperative dexamethasone administration improves postoperative pain control, decreases perioperative opioid requirements, and reduces postoperative nausea.

Clinical care pathways for ambulatory total shoulder arthroplasty

“…Systematic review found that liposomal bupivacaine was comparable to nonliposomal local anesthetics for TSA [17 ▪▪ ]. Some unblinded data indicate that liposomal bupivacaine reduced pain scores after TSA, compared to interscalene catheters [18].…”

“…Routine use of perioperative acetaminophen and nonsteroidal anti-inflammatory drugs is recommended [24 ▪▪ ]. Dexamethasone reduces nausea, improves pain control, and decreases opioid use [17 ▪▪ ]. Gabapentinoids such as gabapentin are often included in pathways [4 ▪▪ ].…”