American Society of Regional Anesthesia and Pain Medicine November 2017 - 17

Contributors:

David Auyong, MD
Staff Anesthesiologist
Virginia Mason Medical Center
Seattle, Washington

Robert B. Maniker, MD
Assistant Professor of
Anesthesiology
Columbia University
New York, New York

An NSAID (oral celecoxib or intravenous ketorolac) would be used
on a case-by-case basis in consultation with the surgeon.
Dr Pawa: Under normal circumstances for this type of surgery, I
would not routinely prescribe oral premedication. In this particular
instance, in the context of preexisting chronic pain, preoperative
opioid and gabapentin use, and significant respiratory disease,
I would prescribe at least her usual drugs prior to the surgical
procedure so at least I would be starting at her baseline.

Brian E. Harrington, MD
Staff Anesthesiologist
Billings Clinic Hospital
Billings, Montana

Amit Pawa, BSc, MBBS, FRCA, EDRA
Consultant Anesthetist
Department of Anaesthesia
Guy's & St Thomas' NHS Foundation Trust
London, United Kingdom

sitting position used for shoulder arthroscopy would make any
additional airway support during the case difficult. Therefore, I
would prefer to secure her airway from the beginning of the case
and use general anesthesia (GA).

Would you offer a regional anesthesia technique? Which
block? Would you use a catheter?
Dr Auyong: I would absolutely offer a regional anesthesia
technique for postoperative analgesia. My approach would be
a continuous suprascapular catheter via an anterior approach.
My research team and I have recently completed two studies
evaluating the anterior approach to the suprascapular nerve, one
of which was published this year. We showed that continuous
suprascapular catheters had equivalent analgesic efficacy as
interscalene catheters but preserved at least 82% of vital capacity
after 24 hours of continuous infusion compared with only 62% for
interscalene catheters. Therefore, in this patient with restrictive
lung disease secondary to obesity and preexisting COPD, I would
prefer an anterior approach suprascapular nerve catheter for
analgesia while maximizing our chances at preserving her lung
function.
Although regional anesthesia could be used for surgical anesthesia,
the patient's baseline oxygen requirement, her obesity, and the

American Society of Regional Anesthesia and Pain Medicine
2017

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Table of Contents for the Digital Edition of American Society of Regional Anesthesia and Pain Medicine November 2017

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