Page written by Dr. Maxime ROLLIN anesthesiologist at the clinic.

You will be operated on the shoulder. This operation requires anesthesia which you will discuss with the anesthetist doctor you will meet in consultation a few weeks or days before your hospitalization

Anesthetics

Except in special cases, the operation will take place under general anesthesia.

Loco-regional anesthesia

In most cases, we will propose to associate with a general anesthesia a loco-regional anesthesia to reduce postoperative pain (and therefore the need for pain medications, especially morphine ).

Beside its desired beneficial effect (decreased pain), the interscalene block is responsible for a number of ‘collateral’ effects, that are not complications, and that you will find may -being:

in almost all cases, it causes transient paralysis (a few hours) of the nerve of the diaphragm , very often without resonance but can rarely be responsible for a temporary sensation of difficulty in breathing,

in two out of three cases, you (or your relatives), may observe a fall of the eyelid on the operated side, again very transient and without any gravity,

in about one in ten cases, you may observe a change for a few hours in the tone of your voice, by anesthesia of the nerve of the vocal cords .

Inter-scalene block

In shoulder surgery, this locoregional anesthesia is called an inter-scalene block because it involves injecting a local anesthetic into a region at the base of the neck called the inter region. -scalénique , close to the nerves responsible for the sensitivity of the shoulder (see photo).

The nerves are marked with an ultrasound machine </ strong>, sometimes associated with a device delivering very weak electrical impulses (neurostimulator).

This loco-regional anesthesia is performed before general anesthesia because it is important that you share your feelings. However, you have already benefited from the infusion of sedation to relax you. This gesture only lasts a few minutes.

Effects

The inter-scalen block has the effect of reducing the sensitivity of the shoulder (desired effect) and the arm. It also causes a decrease in the possibility of movement, or even a ‘paralysis’ of the arm. Depending on the anesthetic product (s) used, the duration of these effects will vary from a few hours to 24-36 hours.

COMPLICATIONS

Finally, like any medical procedure, the inter-scalenic block is likely to lead to complications, sometimes serious. They are rare and for the most serious, very rare (less than one case in a thousand).
– hematoma at the point of puncture,
– infection at the point of puncture,
– accidental puncture of the pleura (pneumothorax),
– diffusion of the product near the spinal cord,
– complications related to the passage of the product in the circulation: convulsions, cardiac arrhythmias or cardiac arrest,
– nerve damage (‘tingling’, paralysis), – transient or, exceptionally, permanent.