2. Introduction
Types of surgical procedures:
1-hemiarthroplasty
2-total shoulder
arthroplasty,
3- shoulder arthroscopy,
4-subacromial decompression,
5-shoulder instability procedures
such as rotator cuff repair.
2
3. Type of the Patient :
fit, robust patient with a
sports injury requiring a
stabilization procedure, to the
frail, elderly rheumatoid patient
requiring joint decompression
or arthroplasty.
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4. Do we Need regional
anesthesia ??
Shoulder surgery is associated
with significant postoperative
pain, but mobilization and
physiotherapy often begin on
the first postoperative day.
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5. regional nerve block
intra-articular analgesia with or
without continuous infusion
local anaesthetic wound infiltration
conventional oral and parenteral
analgesia;
5
20. Indications
• Preoperative :conditions where interscalene
block is contraindicated, open and
arthroscopic shoulder procedures .....rotator
cuff surgery ???!!.
• Postoperative : interscalene failure, catheter
displacement ....
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21. Suprascapular nerve block
"technique of Meier"
The technique chosen was that
described by Meier, which allows
blockade of the suprascapular
nerve during its passage from the
suprascapular notch to the
spinoglenoid notch
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30. Axillary nerve block
"technique of Price"
The safest and most consistent point at which
to block the axillary nerve is immediately
following this nerve’s passage through the
quadrilateral space to lie on the posterior
surface of the humerus.
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37. If no twitches are elicited on first pass, the
needle tip should be walked up and down the
posterior surface the humerus, If twitches are
still not elicited, 10 to 15ml of LA can be
deposited beneath the deltoid on the posterior
surface of the humerus at the initial entry point.
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39. Summary
The evidence indicates that the
suprascapular and/or axillary nerve
blocks are not as effective as an
interscalene block. However in patients
who are not candidates for the
interscalene block, these blocks may
provide a useful alternative for short-
term pain relief.
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