Introduction to Anesthesia - Surgical Guide to Left Total Shoulder Replacement

Prior to your surgery, your anesthesiologist will see you to review your physical condition and to discuss the type of anesthesia you will receive. Most patients undergoing shoulder surgery have regional anesthesia. General anesthesia is rarely used.

Overview of regional anesthesia

These four terms help clarify how regional anesthesia relates to your shoulder operation:

• Anesthesia
  The partial, or total loss of sensation in a body area or the whole body.
• Anesthetic
  The agent (drug) that induces anesthesia.
• Local anesthetic
  An anesthetic applied directly to a specific location, providing anesthesia (loss of sensation) to that immediate area.
• Regional anesthetic
  An anesthetic which produces anesthesia (loss of sensation) in the given region or area of your body containing the surgical site. The regional anesthetic is applied remotely in a specific location (your shoulder area) where it “blocks” a group of nerves that otherwise would carry sensations of pain from the shoulder surgery site.

The anesthesiologist will review your medical history and chart, confirm with you the correct site of the operation, and explain the anesthesia plan. After having all of your questions answered, you will be presented with the anesthesia consent form. At HSS, the anesthetic plan for shoulder replacement will most likely entail a nerve block of the brachial plexus and sedation. With this type of anesthesia, known as regional anesthesia, local anesthetics will be injected around the nerves going to your shoulder in order to make certain you experience no pain during the surgery. An ultrasound is used for the nerve block to ensure the local anesthetic is injected into the correct location. As a result of using regional anesthesia, you will require less sedative and pain medication, which would enable you to recover faster, feel more comfortable, and experience fewer side effects, such as sleepiness and nausea. You will be sedated prior to the nerve block and afterward be placed in a deeper sleep for the surgery. Depending on the extent of the surgery, a catheter may be placed to allow more local anesthetic to be injected around the nerves to help minimize the pain after surgery.

Some cases of shoulder replacement are performed under general anesthesia, either alone or in combination with the regional anesthesia. General anesthesia involves being put to sleep with medications that are given through your intravenous line. Once you are completely asleep, a breathing device is placed into your mouth and your anesthesiologist will assist your breathing with a ventilator. You will remain completely asleep until the surgery is complete, at which time you will start breathing on your own and wake up comfortably in the operating room.