Phrenic Nerve Palsy and Regional Anesthesia for Shoulder Surgery: Anatomical, Physiologic, and Clinical Considerations

Anesthesiology
Kariem El-BoghdadlyVincent Chan

Abstract

Regional anesthesia has an established role in providing perioperative analgesia for shoulder surgery. However, phrenic nerve palsy is a significant complication that potentially limits the use of regional anesthesia, particularly in high-risk patients. The authors describe the anatomical, physiologic, and clinical principles relevant to phrenic nerve palsy in this context. They also present a comprehensive review of the strategies for reducing phrenic nerve palsy and its clinical impact while ensuring adequate analgesia for shoulder surgery. The most important of these include limiting local anesthetic dose and injection volume and performing the injection further away from the C5-C6 nerve roots. Targeting peripheral nerves supplying the shoulder, such as the suprascapular and axillary nerves, may be an effective alternative to brachial plexus blockade in selected patients. The optimal regional anesthetic approach in shoulder surgery should be tailored to individual patients based on comorbidities, type of surgery, and the principles described in this article.

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Citations

Jul 14, 2018·Current Opinion in Anaesthesiology·Michael J Barrington, Yoshiaki Uda
Jul 4, 2019·Anaesthesia·L R TurbittK El-Boghdadly
Aug 2, 2019·Pain Medicine : the Official Journal of the American Academy of Pain Medicine·Laurent BlascoFabrice Ferre
Jan 28, 2020·Anaesthesia·E R Mariano, K El-Boghdadly
Feb 27, 2020·Anesthesiology·Hongye ZhangZongyang Qu
Aug 23, 2020·Current Opinion in Anaesthesiology·Javier CubillosFelipe Muñoz-Leyva
May 8, 2018·Clinical Anatomy : Official Journal of the American Association of Clinical Anatomists & the British Association of Clinical Anatomists·Pierre LaumonerieVincent Minville
Mar 27, 2020·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·Sui An LieShin Yuet Chong
Mar 15, 2019·Regional Anesthesia and Pain Medicine·Herman SehmbiShalini Dhir
Jul 28, 2020·Journal of Anesthesia·Kunihisa Hotta
Jan 15, 2021·Regional Anesthesia and Pain Medicine·Laura Girón-Arango, Anahi Perlas
Mar 20, 2021·Anaesthesia Reports·J QuerneyI Sebbag
Apr 26, 2021·Brazilian Journal of Anesthesiology·Nina CugninEdmundo Pereira de Souza Neto
Sep 22, 2021·The Journal of Vascular Access·Kaitlin WoodsHeather K Hayanga
Oct 29, 2021·Anesthesiology·David LagierMarcos F Vidal Melo

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