title: Regional Anesthesia With Noninvasive Ventilation for Shoulder Surgery in a Patient With Severe Chronic Obstructive Pulmonary Disease: A Case Report.
abstract: Interscalene block (ISB) impairs ipsilateral lung function and generally is not used for patients with respiratory insufficiency. We present a 49-year-old man with chronic obstructive pulmonary disease scheduled for shoulder surgery. He was given a regional technique with an ISB (short-acting local anesthetic to minimize duration of diaphragmatic dysfunction) and suprascapular and axillary nerves blocks (long-acting local anesthetic). He was supported with noninvasive ventilation during the time of hemidiaphragmatic paralysis as documented by serial ultrasound examination. A discussion about ISB and its alternatives (general anesthesia versus brachial plexus block versus selective peripheral nerve blocks) always should occur for patients at risk for pulmonary complications.
authors.affiliation: From the *Department of Anesthesiology and Critical Care Medicine, Purpan University Hospital, Toulouse, France; †Department of Anesthesia, Clinique Médipôle Garonne, Toulouse, France; ‡Department of Orthopedic Surgery, Purpan University Hospital, Toulouse, France; and §Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Ferré
authors.forename: Nina
authors.initials: N
authors.lastname: Cugnin
authors.forename: Charlotte
authors.initials: C
authors.lastname: Martin
authors.forename: Philippe
authors.initials: P
authors.lastname: Marty
authors.forename: Nicolas
authors.initials: N
authors.lastname: Bonnevialle
authors.forename: Matt
authors.initials: M
authors.lastname: Kurrek
authors.forename: Vincent
authors.initials: V
authors.lastname: Minville
mesh_terms: D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000009:adverse effects / Q000379:methods*; D063087:Noninvasive Ventilation; D019637:Orthopedic Procedures; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D012133:Respiratory Paralysis / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D012307:Risk Factors; D000070636:Rotator Cuff Injuries / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D012720:Severity of Illness Index; D012785:Shoulder Joint / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D000779:Anesthetics, Local