Interscalene block for elective musculoskeletal shoulder surgery in patients with obstructive sleep apnea – Is it safe?

Abstract

Objectives: Obstructive sleep apnea (OSA) patients increasingly require shoulder surgery. Their management can be complex for anesthetists and surgeons. Interscalene nerve blocks are used routinely in shoulder surgery, providing adequate analgesia. This study aimed to investigate whether using an interscalene block in patients with OSA is associated with increased postoperative complications and morbidity when undergoing elective musculoskeletal shoulder surgery. Methods: Patients undergoing elective musculoskeletal shoulder operations with OSA were recruited for the study. They received an interscalene brachial plexus nerve block, with or without general anesthesia. Continuous positive airway pressure (CPAP) was used routinely in the perioperative period. Patients were followed up at 24 h and 30 days postoperatively. Patients were reviewed for complications, recovery time, and length of hospital stay. Results: Thirty-one patients were included in the study: 20 arthroscopic and 11 open shoulder procedures. No patients suffered any perioperative morbidity or mortality in the first 24 h or 30-day follow-up periods. There were no complications nor high dependency unit admissions. Conclusion: This study indicates that OSA patients may safely undergo musculoskeletal shoulder surgery with an interscalene nerve block without an increase in perioperative morbidity and mortality. The use of an interscalene nerve block is important as it reduces or eliminates the use of opioids. Furthermore, CPAP use assists in preventing common complications related to the OSA cohort, facilitating day-case surgery.