Dr Mark Lennon
Anaesthetist
Sir Charles Gairdner Hospital
Hospital Avenue
Nedlands
Perth, WA 6009
AUSTRALIA
Bethesda Hospital
25 Queenslea Drive
Claremont
Perth, WA 6010
AUSTRALIA
Hollywood Private Hospital
Monash Avenue
Nedlands
Perth, WA 6009
AUSTRALIA
ROTATOR CUFF REPAIR SURGERY
ANAESTHESIA AND PAIN RELIEF FOR ROTATOR CUFF REPAIR SURGERY
Rotator cuff repair surgery involves a full general anaesthetic and usually an additional form of pain relief called a nerve block. This type of surgery can be painful to recover from and the nerve block has been found to be very useful in relieving this pain in the first 12-24 hours after surgery. An ultrasound guided injection of local anaesthetic will be administered carefully around these nerves to partially numb the shoulder to improve your comfort levels. Other effects include some pins and needles and weakness of the arm and hand. Occasionally, the whole arm may go completely numb for a period of time but this is fully reversible and uncommon. Prolonged numbess of a patch of skin in the arm or hand lasting longer than 1-2 days is possible in a small percentage of patients but the majority will completely resolve over a few weeks. This may result from the effects of the surgery, your positioning during the operation or from the nerve block itself. Serious nerve injury resulting in weakness of the arm or hand is very rare.
The nerve block will "wear off" sometime between 12 and 24 hours after surgery. At this time the shoulder may start to become uncomfortable and you are likely to need quite strong additional pain relief. To smooth the offset of the nerve block, a long acting anti-inflammatory injection in theatre and a 'slow release' Tapentadol tablet will have been given prior to the block wearing off. Tapentadol (Palexia) IR will be available during the transition phase to ease your discomfort.
CONTINUOUS NERVE BLOCK FOR SHOULDER OPERATIONS
Some patients will be offered a continuous nerve block technique where a small plastic tube is placed next to the nerves of the shoulder to provide sustained pain relief for several days. The tube will be connected to a small portable pump that will supply local anaesthetic to the area. This results in a partially numb shoulder with reduced pain signals. Anticipated effects from this include less pain but also some weakness of the muscles of the shoulder. This may also include numbness and weakness of the arm and hand as all the nerves are close together. The usual plan is to run the infusion at a low does to provide pain relief and reduce the effect on the muscles. With this approach the infusion may need to be “topped-up” from time to time. It will be typically programmed to provide ~2mls per hour as a background rate and then if you need a top up you press the top-up button (see link below) and an additional 5 mls will be administered. This top up function will be available every 4 hours. This can be useful at night for example where more pain relief is helpful while having a slightly more numb arm is not a problem. The infusion can continue for up to 5 days after your surgery. The benefits of continuing the infusion for this period is better pain relief and reduced need for strong pain medications, which can have unpleasant side effects.