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Case Reports in Anesthesiology
Volume 2013 (2013), Article ID 986386, 4 pages
http://dx.doi.org/10.1155/2013/986386
Case Report

Perioperative Management of Interscalene Block in Patients with Lung Disease

Department of Anesthesiology, Jefferson Medical College, Suite 8490, 111 South 11th Street, Philadelphia, PA 19107, USA

Received 16 September 2013; Accepted 27 October 2013

Academic Editors: R. S. Gomez and J. G. Jakobsson

Copyright © 2013 Eric S. Schwenk et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Interscalene nerve block impairs ipsilateral lung function and is relatively contraindicated for patients with lung impairment. We present a case of an 89-year-old female smoker with prior left lung lower lobectomy and mild to moderate lung disease who presented for right shoulder arthroplasty and insisted on regional anesthesia. The patient received a multimodal perioperative regimen that consisted of a continuous interscalene block, acetaminophen, ketorolac, and opioids. Surgery proceeded uneventfully and postoperative analgesia was excellent. Pulmonary physiology and management of these patients will be discussed. A risk/benefit discussion should occur with patients having impaired lung function before performance of interscalene blocks. In this particular patient with mild to moderate disease, analgesia was well managed through a multimodal approach including a continuous interscalene block, and close monitoring of respiratory status took place throughout the perioperative period, leading to a successful outcome.