Provision of Anaesthesia for Shoulder Surgery- A Case Load Analysis_ Crimson Publishers

 Provision of Anaesthesia for Shoulder Surgery- A Case Load Analysis by Zhaosheng Jin* in Developments in Anaesthetics & Pain Management_ Developments in Anaesthetics & Pain Management

 

Abstract
Over the years a number of techniques have been developed to address the postoperative analgesic requirement in shoulder surgeries. The introduction of catheter based technique for interscalene block now enables longer lasting analgesic effect and is now considered to be the gold standard postoperative analgesia in complex shoulder surgery. However, its use is often limited by the staffing and resources constraints. In this case load analysis, we seek to investigate the anaesthetic practice of our busy district general hospital and how it compares to the gold standard treatment.

 Introduction
The shoulder is an anatomically complex joint involving bone, cartilage, capsule, tendon and muscle. Pathology could develop from any of these structure and lead to surgical intervention. In shoulder surgery physiotherapy forms a vital part of the postoperative rehabilitation however it is often limited by significant postoperative pain [1].

More recently a number of techniques have been used to manage the postoperative pain in shoulder surgery, this include intra-Articular local anaesthetics, supraclavicular axillary and interscalene nerve blocks. It has been shown that interscalene and supraclavicular block in shoulder surgery has been associated with significantly reduced Perioperative Opioid requirement and Opioid related adverse effects, as well as significantly faster postoperative recovery [2-5]. However, the limitation of such technique is the relatively short duration of its analgesic effect.

The development of the catheter based technique for the interscalene block now allows for continuous administration of local anaesthetic agent and as a consequence, a significantly longer analgesic duration. In a number of clinical trials and metaanalysis, interscalene catheter technique has been demonstrated to have significantly better analgesic effect than single interscalene injection [6,7]. It is considered to be the gold standard in terms of Perioperative analgesia for complex shoulder surgery. However, due to the higher skill requirement for insertion of the catheter, as well as need for 24-hours-a-day follow up service, its use is not widely implemented. In this case load analysis, we will investigate how the resources and anaesthetic practice of our high throughput, publically funded district general hospital compare to the gold standard treatment.

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