The American journal of orthopedics
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Case Reports
Tension Pneumothorax After Ultrasound-Guided Interscalene Block and Shoulder Arthroscopy.
Interscalene brachial plexus anesthesia is commonly used for outpatient arthroscopic shoulder procedures. Ultrasound guidance has helped to minimize the cardiac, neurologic, and pulmonary complications associated with this block. ⋯ We present a case of tension pneumothorax in a patient undergoing arthroscopic rotator cuff repair under both interscalene regional and general anesthesia. Surgeons and anesthesiologists must remain aware that ultrasound-guided interscalene blocks may be associated with pneumothorax and must initiate treatment expeditiously.
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Despite advances in the understanding of postoperative pain, approximately 80% of surgical patients still experience a meaningful level of pain, which can result in unnecessary stress and suffering; compromise the patient's progress, recovery, and outcome; and lead to poor function and the development of chronic pain. In arthroplasty patients, the goals of pain management include improving comfort and satisfaction, enabling patients to ambulate and move their joints soon after surgery, and, where appropriate, reducing the hospital length of stay. ⋯ Furthermore, as-needed administration of opioids allows for the repeated return of pain after the operation as each dose wears off. A balanced multimodal approach that combines different anesthetic and analgesic modalities in a rational way to target the distinct pain pathways, rather than relying predominantly on opioid drugs, is essential for effective control of postoperative pain, avoiding the risk of opioid-related adverse events and complications, reducing length of stay, and improving longterm outcomes.
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There is growing concern about the emergence of an "opioid epidemic" in the United States, where the abuse of opioids has had a devastating impact on public health and safety. Around 250 million prescriptions for pain medication are now written each year in this country, and 46 people die from an overdose of a prescription pain medication every day. ⋯ A variety of government organizations and expert groups, such as the American Society of Anesthesiologists Task Force on Acute Pain Management, now recommend multimodal analgesia and weighing the benefits and risks of systemic opioids. The Joint Commission also has recommended that strategies for pain management include a patient-centered approach that takes into consideration the accompanying risks and benefits--including the potential risk of dependency, addiction, and abuse.