Your Regional Anesthesia Procedure - Surgical Guide to Right Total Shoulder Replacement

IV line inserted
Before administering any regional anesthetic, it is necessary to have an intravenous (IV) line in place. Your IV line provides a route for fluids, medications, and antibiotics, as necessary, and also for sedatives, including the one used for your initial sedation.

Initial sedation
Before receiving the injection for regional anesthesia you will be mildly sedated (via the IV) to reduce possible anxiety and tension, and to minimize pain from the application of local anesthetic which proceeds the regional one.

Administration of local anesthetic
After initial sedation, a very small amount of a local anesthetic is injected at your lower neck where the regional anesthetic will be applied. The initial sedation minimizes the discomfort.

Administering regional anesthesia
The type of regional anesthetic used for shoulder procedures is called an Interscalene Block. A regional anesthetic is injected through a very small, thin needle in your lower neck. Because of the initial sedation and local anesthetic, you will feel very little discomfort as this is done. You will gradually lose feeling in the shoulder and upper arm, but your forearm and hand are usually affected. Shortly thereafter, you will be moved to the operating room.

What to expect during surgery with regional anesthesia
In the operating room you are not left alone. You will be able to see the anesthesia team, who will remain with you, monitoring your vital signs. They may ask how you feel and you may talk or ask questions. You may hear the surgical team talking, but a “curtain” will prevent you from seeing those at the surgical site. In any event, you will not feel the surgical procedure.

Choosing to “sleep”
If you would like to be completely unaware of the surgical procedure, tell your anesthesiologist when he/she first talks to you. You will be given a sedative through your IV line. You will wake up in the recovery room while waiting for your regional anesthesia to wear off.

Your recovery
In the recovery room your anesthesiologist and the recovery room team will monitor your safe transition from effects of anesthesia.

Transition to pain medication after regional anesthesia
Because the level of sedation and anesthesia are kept at the necessary minimum, you will awake soon after surgery. However, the anesthetic effect in your shoulder region usually dissipates over a period ranging from 8-36 hours. When the nerve block begins to wear off, you will feel a tingling sensation, like pins and needles. It is important that you start taking the pain medication at that time to ensure that you stay ahead of the pain.

Don’t try to “tough it out” with pain
Take your pain medication as prescribed. You will rest more comfortably and be better able to carry on with your assigned exercise program and other physical activities, which your surgery permits. You will be asked to rate how much pain you have on the pain scale below.

Rate your pain or pain relief from 0-10